Considering Exercise-Based, Fall

Prevention Home Programs and

Education to Increase Adherence and
Self-efficacy: Building Long Term Habits
for Improved Quality of Life
Harrison Ogle, SPT
PTP III: Ohio Health Rehabilitation Hospital
Why Does This Matter?
Benefits of In-patient Rehabilitation
• 15 hours of intense therapy and rehabilitation a week
• Physical and therapeutic activity completed 5/7 days
• Increased time spent with patients
• Frequent delivery of education
• Frequent monitoring of patient progress and assessment of functional
outcome measures
• Ability to build an exercise log and HEP that best suits patient
• Address Barriers to discharge on a daily basis

• Family Training
• Caregivers have the opportunity to see and understand impairments and
guard appropriately
Inherently, the in-patient rehab setting facilitates:
1. Use it or lose it
2. Repetition matters
3. Intensity matters
4. Time matters

Principles we further facilitate as clinicians:

1. Use it and improve it
2. Salience matters
3. Specificity matters
4. Transference Matters
5. Interference matters
 In-patient vs. Home Health vs. Outpatient
In-patient Setting Home Health Care Outpatient Setting
• 3 hours a day, 5 days • 2-3 times a week; 45 • 2-3 times a week;
a week minute – 1 hour 30 minute – 1
• Services provided sessions
hour sessions
“in house” • Completed in home
setting • Transportation to
• 24 – hour Nursing and from clinic
care available • Family/caregiver
may or may not be • Limited
• Family Training
sessions present availability
• Insurance Limiting • Insurance limiting
visits visits
 Goals and Benefits of HEP + Education
• Improved patient outcomes
• Improved balance and gait
• Improved functional mobility
• Improved ROM and strength
• Improvements in overall health
and wellness
• Improved health literacy
• Improved self-efficacy
• Improvements in behaviors and
motivation
• Decreases in fear of falling
Reality of HEP + Education
• It has been found that up to 50% of patients
are not adherent to their home exercise
program
• Identified barriers include: fear of falling, loss of
interest, time constraints, and low outcome
expectations

• Types of interventions included in the Home

Exercise Program may have an effect on
adherence

• Clinician is the expert vs. Patient is the expert

Clinic vs. Home/Community
What does the evidence suggest?
• Strengthening, balance, and aerobic training all reduce the risk and rate of
falls by 17-30%
• Increased adherence to HEP noted when balance training was included
• Walking had both a positive and negative effect on adherence and effectiveness
based on patient’s risk for falls

• 50 hours of structured, exercise-based programs over 3-6 months results is

highly effective at reducing risk and rate of falls

• Task specific training vs. single intervention

• Task specific training is more effective than stand alone intervention
• Single intervention with explanation of purpose and relation to task improves
adherence and may improve effectiveness

• Patients with subacute stroke who received strength and balance training, as
well as walking after discharge from outpatient therapy showed significant
improvements in mobility, endurance, and a decrease in falls

• Community based, group exercise programs can contribute to decreases in

fall risk and improved mobility when appropriate

• PATIENTS SHOULD HAVE A ROLE IN FORMULATING AND CONSTRUCTING

THEIR HEP
How can we help?
• Educating patients on the benefits of physical
activity in progressing their functional mobility
and improving quality of life
• Establishing a HEP and explaining its purpose
and benefits during their rehab journey
• Being a patient advocate and catalyst in
promoting self-efficacy
• Allow the patient to be a part of management and
decision making (when appropriate)

• Promoting a holistic and exercise-based

approach for further management of health
References:
1. Argent R, Daly A, Caulfield B. Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence?. JMIR Mhealth
Uhealth. 2018;6(3):e47. Published 2018 Mar 1. doi:10.2196/mhealth.8518
2. Avin KG, Hanke TA, Kirk-Sanchez N, et al. Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical
Therapy of the American Physical Therapy Association. Phys Ther. 2015;95(6):815-834. doi:10.2522/ptj.20140415
3. Grabiner, Mark D.; Crenshaw, Jeremy R.; Hurt, Christopher P.; Rosenblatt, Noah J.; Troy, Karen L.. Exercise-Based Fall Prevention: Can You Be a Bit More Specific?.
Exercise and Sport Sciences Reviews 42(4):p 161-168, October 2014. | DOI: 10.1249/JES.0000000000000023
4. Shubert, Tiffany E. MPT, PhD. Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of the Literature. Journal of Geriatric Physical
Therapy 34(3):p 100-108, July/September 2011. | DOI: 10.1519/JPT.0b013e31822938ac
5. Simek EM, McPhate L, Haines TP. Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of
exercise program characteristics. Preventive Medicine. 2012;55(4):262-275. doi:10.1016/j.ypmed.2012.07.007
6. Forkan R, Pumper B, Smyth N, et al. Exercise Adherence Following Physical Therapy Intervention in Older Adults With Impaired Balance, Physical Therapy, Volume 86,
Issue 3, 1 March 2006, Pages 401–410, https://doi.org/10.1093/ptj/86.3.401
7. Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: A systematic review and meta-analysis. British
Journal of Sports Medicine. 2016;51(7):586-593. doi:10.1136/bjsports-2015-095452
8. Taricco M, Dallolio L, Calugi S, et al. Impact of Adapted Physical Activity and Therapeutic Patient Education on Functioning and Quality of Life in Patients With
Postacute Strokes. Neurorehabilitation and Neural Repair. 2014;28(8):719-728. doi:10.1177/1545968314523837
9. King LA, Wilhelm J, Chen Y, et al. Effects of Group, Individual, and Home Exercise in Persons With Parkinson Disease: A Randomized Clinical Trial. J Neurol Phys Ther.
2015;39(4):204-212. doi:10.1097/NPT.0000000000000101
10. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev.
2012;2012(9):CD007146. Published 2012 Sep 12. doi:10.1002/14651858.CD007146.pub3
11. Moncada LVV, Mire LG. Preventing Falls in Older Persons. Am Fam Physician. 2017;96(4):240-247.
12. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: A systematic review and meta‐analysis. Journal
of the American Geriatrics Society. 2008;56(12):2234-2243. doi:10.1111/j.1532-5415.2008.02014.x
13. Morris, J.N., Howard, E.P., Steel, K. et al. Strategies to reduce the risk of falling: Cohort study analysis with 1-year follow-up in community dwelling older adults. BMC
Geriatr 16, 92 (2016). https://doi.org/10.1186/s12877-016-0267-5
14. Gallo, Estelle PT, DPT, NCS; Stelmach, Maria PT, DPT, NCS; Frigeri, Fernanda PT, PhD; Ahn, Dong-Hyun ScM. Determining Whether a Dosage-Specific and Individualized
Home Exercise Program With Consults Reduces Fall Risk and Falls in Community-Dwelling Older Adults With Difficulty Walking: A Randomized Control Trial. Journal of
Geriatric Physical Therapy 41(3):p 161-172, July/September 2018. | DOI: 10.1519/JPT.0000000000000114