Otago exercise program in the United States: Comparison of 2 implementation models

Background. The Otago Exercise Program (OEP) is an evidence-based fall prevention program delivered by a physical therapist in 6 visits over a year. Despite documented effectiveness, there has been limited adoption of the OEP by physical therapists in the United States. To facilitate dissemination, 2 models have been developed: (1) the US OEP provided by a physical therapist or physical therapist assistant in the home or outpatient setting and (2) the community OEP provided by a non–physical therapist and a physical therapist consultant. It is unknown whether such modifications result in similar outcomes. Objective. The aims of this study were to identify the components of these 2 models, to compare participant characteristics for those components reached by each model, and to examine outcome changes by model and between models. Design. This was a translational cohort study with physical therapists implementing the US OEP and trained providers implementing the community OEP. Methods. Data for physical performance, sociodemographic characteristics, and self-perception of function were collected at baseline and at 8 weeks. Results. Participants in the community OEP were significantly younger and reported more falls compared with those in US OEP. Both sites reported significant improvements in most physical and self-reported measures of function, with larger effect sizes reported by the community OEP for the Timed “Up & Go” Test. There was no significant difference in improvements in outcome measures between sites. Limitations. This was an evaluation of a translational research project with limited control over delivery processes. The sample was 96% white, which may limit application to a more diverse population. Conclusion. Alternative, less expensive implementation models of the OEP can achieve results similar to those achieved with traditional methods, especially improvements in Timed “Up & Go” Test scores. The data suggest that the action of doing the exercises may be the essential element of the OEP, providing opportunities to develop and test new delivery models to ensure that the best outcomes are achieved by participants.