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R. Dawson1, C. Sherrington2, K. Nelson3, N. Bowes4, A. Hayes1
1University of Sydney, Institute for Musculoskeletal Health, Sydney, Australia, 2University of Sydney, Institute for Musculoskeletal, Sydney, Australia, 3Whiddon, Sydney, Australia, 4Uniting AgeWell, Melbourne, Australia
Background: Physiotherapy enhances quality of life by increasing mobility and reducing falls. Telehealth decreases healthcare costs, increases accessibility for older people living in rural areas and is considered safe and effective in primary care. However, little is known about how aged care users experience telehealth, or how it can be optimised in this context.
Purpose: The TOP UP Study is a hybrid type 1 effectiveness and implementation trial that is testing a 6-month telehealth physiotherapy intervention in aged care that aims to improve mobility, quality of life and reduce falls. The TOP UP study will report on effectiveness, cost effectiveness and implementation measures. This qualitative process evaluation will help us to understand how and why TOP UP worked (or not) and what strategies could best improve the intervention and its implementation.
Methods: We are conducting a theory-informed evaluation guided by behavioural theories to explore stakeholder perspectives about the acceptability, feasibility and function of the intervention. Data sources include purposively sampled interviews with older people who received the telehealth intervention (n=18), aged care workers who acted as exercise coaches (n= 9), physiotherapists who delivered the intervention (n=7) and aged care managers (n = 8).
Results: Findings indicate that the TOP UP intervention works well for all participants due to the convenience of receiving telehealth in their own home, the reduced burden of travel and telehealth’s ability to enhance the quality and frequency of home exercise programs. Physiotherapists report that while telehealth requires more time to ‘get to know’ their clients it does not prevent participants from developing a trusting relationship which was key to the success of the program.
Senior-friendly online exercise resources encouraged participants’ exercise adherence and motivation. Participants report that ‘seeing someone like themselves’ doing the exercises gave them confidence to try. They highlighted the importance of the flexible and autonomous approach to their program which empowered them to choose exercise according to their time demands and health needs on the day.
Physiotherapists and managers identified key aspects of technology and human infrastructure required to support telehealth and agreed that telephysio is safe in aged care. All stakeholders indicated that the aged care worker’s reablement approach is required to build autonomy with unsupervised practice and competence with using telehealth technology. This ‘doing with’ approach is crucial to the sustainability of telehealth physiotherapy programs in aged care.
Senior-friendly online exercise resources encouraged participants’ exercise adherence and motivation. Participants report that ‘seeing someone like themselves’ doing the exercises gave them confidence to try. They highlighted the importance of the flexible and autonomous approach to their program which empowered them to choose exercise according to their time demands and health needs on the day.
Physiotherapists and managers identified key aspects of technology and human infrastructure required to support telehealth and agreed that telephysio is safe in aged care. All stakeholders indicated that the aged care worker’s reablement approach is required to build autonomy with unsupervised practice and competence with using telehealth technology. This ‘doing with’ approach is crucial to the sustainability of telehealth physiotherapy programs in aged care.
Conclusions: COVID-19 has fast-tracked the uptake of telehealth services in aged care. Preliminary findings show that with support and education many older people can adapt to using telehealth to access physiotherapy and exercise. We believe our theory-informed, multi-perspective evaluation will produce transferable learnings about the use of telehealth physiotherapy in aged care.
Implications: Our aged care partners have taken on the initial learnings from the TOP UP Study and begun delivering telehealth physiotherapy. Their programs aim to give older people choice about how and where they receive mobility and fall prevention programs and are providing aged care consumers in remote areas the opportunity to receive restorative physiotherapy for the first time
Funding acknowledgements: Rik Dawson is supported by a PhD scholarship from the Centre of Research Excellent in the prevention of falls.
Keywords:
Aged care
Telehealth
Mobility
Aged care
Telehealth
Mobility
Topics:
Older people
Innovative technology: information management, big data and artificial intelligence
Community based rehabilitation
Older people
Innovative technology: information management, big data and artificial intelligence
Community based rehabilitation
Did this work require ethics approval? Yes
Institution: Sydney Local Health District
Committee: Concord
Ethics number: CH62/6/2021-009
All authors, affiliations and abstracts have been published as submitted.
