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Hale L1, Vollenhoven E1, Caiman L2, Dryselius A2, Buttery Y3
1University of Otago, School of Physiotherapy, Dunedin, New Zealand, 2Umeå University, Unit of Physiotherapy, Umea, Sweden, 3University of Otago, Dunedin, New Zealand
Background: In one year 30-60% adults with intellectual disability (ID) experience a fall. In this population, falls are the primary cause of injury and can lead to fear of falling and reduced physical activity participation. Adults with ID start having falls at a younger age (>42 years) than the general population (>65 years). Multi-factorial fall risks factors are identified, with mobility problems (poor balance and gait) keys factors that are potentially modifiable. Exercise-based fall prevention programmes are emerging and are at the feasibility stage of investigation, such as group-delivered Otago Exercise Programme (OEP) and Prevention of Falls for Adults with ID (PROFAID) intervention. As these interventions develop, exploring their characteristics to target appropriate client groups is warranted.
Purpose: This study explored the characteristics that determine client suitability to group OEP and to PROFAID for adults with ID, specifically exploring viability and acceptability.
Methods: A multiple case study of adults with ID completing either group OEP (n=3) or PROFAID (n=4). Participants were adults, any level of ID, at risk of falling but safe to exercise. Data were collected from multiple sources (semi-structured interviews with participants and support workers, observations, attendance / adherence, falls, adverse events) and analysed using an integrated approach.
Results: Three themes enabled understanding of suitability of people to each intervention: suitability of the exercises; role of the environment; and benefits to participants. Group OEP was achievable and acceptable, but attending participants all had mild levels of ID (lived independently with support); they easily understood the exercises and reasons for them. They reported enjoying the social and safe atmosphere. Adherence was good. Due to varying ambulatory status however, most exercises required modification and a high level of supervision to ensure safety. In contrast, the four PROFAID participants had differing levels of ID and adherence was variable. For one high functioning, independent participant; daily exercises was easily adhered to, requiring only subtle reminders from his support worker, and he understood the need and importance of them. In contrast, for two participants with severe ID, their adherence to PRPOFAID was completely contingent on the level of support received from their support workers and the value they ascribed to exercise. The fourth participant lived independently but had mental health problems that lead to poor adherence in spite of variety of support offered, not the programme itself.
Conclusion(s): Irrespective of level of ID, key to participation in exercise fall prevention programmes is education of the individual and their support people of the importance of regular exercise. Both group OEP and PROFAID required high levels of support, prioritisation and individualisation to ensure exercises occurred, and occurred safely.
Implications: Whilst robust evidence is limited, exercise appears vital to reducing falls risk for adults with ID. Group OEP or PROFAID are possible solutions, but both require high levels of supervision and buy-in from those that support the individual. However, high levels of supervision for exercise are potentially more desirous than the costs and consequences of frequent and serious falls.
Keywords: Intellectual disability, Falls prevention, Exercise
Funding acknowledgements: N/A
Purpose: This study explored the characteristics that determine client suitability to group OEP and to PROFAID for adults with ID, specifically exploring viability and acceptability.
Methods: A multiple case study of adults with ID completing either group OEP (n=3) or PROFAID (n=4). Participants were adults, any level of ID, at risk of falling but safe to exercise. Data were collected from multiple sources (semi-structured interviews with participants and support workers, observations, attendance / adherence, falls, adverse events) and analysed using an integrated approach.
Results: Three themes enabled understanding of suitability of people to each intervention: suitability of the exercises; role of the environment; and benefits to participants. Group OEP was achievable and acceptable, but attending participants all had mild levels of ID (lived independently with support); they easily understood the exercises and reasons for them. They reported enjoying the social and safe atmosphere. Adherence was good. Due to varying ambulatory status however, most exercises required modification and a high level of supervision to ensure safety. In contrast, the four PROFAID participants had differing levels of ID and adherence was variable. For one high functioning, independent participant; daily exercises was easily adhered to, requiring only subtle reminders from his support worker, and he understood the need and importance of them. In contrast, for two participants with severe ID, their adherence to PRPOFAID was completely contingent on the level of support received from their support workers and the value they ascribed to exercise. The fourth participant lived independently but had mental health problems that lead to poor adherence in spite of variety of support offered, not the programme itself.
Conclusion(s): Irrespective of level of ID, key to participation in exercise fall prevention programmes is education of the individual and their support people of the importance of regular exercise. Both group OEP and PROFAID required high levels of support, prioritisation and individualisation to ensure exercises occurred, and occurred safely.
Implications: Whilst robust evidence is limited, exercise appears vital to reducing falls risk for adults with ID. Group OEP or PROFAID are possible solutions, but both require high levels of supervision and buy-in from those that support the individual. However, high levels of supervision for exercise are potentially more desirous than the costs and consequences of frequent and serious falls.
Keywords: Intellectual disability, Falls prevention, Exercise
Funding acknowledgements: N/A
Topic: Older people
Ethics approval required: Yes
Institution: University of Otago
Ethics committee: Human Ethics Committee
Ethics number: H14/155
All authors, affiliations and abstracts have been published as submitted.
