Strategies & Ideas
Otago exercise program
Objective / Description
Introduction of the Otago Exercise Program, (developed in New Zealand), in Reutlingen: The Otago Exercise Program has the aim to improve/maintain independence and prevent falls in frail elderly people. The objective is to teach participants an exercise program, which improves strength and balance, and that these participants carry out the program regularly and independently. To achieve this goal, physiotherapists and occupational therapists visit the participating older people at home five times during 6 months, to show them how to do the exercises. During the time between the home visits, 3 calls are made to clarify issues and enhance motivation.
The effectiveness of the program has already been proven by various studies. There are some countries, where the Otago Exercise Program is being financed by the health system. Yet, within the German health system, there are hardly any opportunities for the target group to receive an offer of fall prevention classes, so far.
The challenges that had to be dealt with during the project were the following: Sponsors had to be convinced to finance the Otago Exercise Program. To carry out the program, infrastructure had to be created, meaning that therapists had to be instructed and doctors and the public had to be informed. Furthermore, processes had to be defined and various documents had to be created, to enable a constructive cooperation between doctors, therapists and health insurance services.
- Negotiations with health insurance services
- Information and training of physiotherapists and occupational therapists: All of Reutlingen's physiotherapists and occupational therapists were invited to a first information evening, where the program and the planned procedures were introduced. Registration forms for a free training, consisting of 8 teaching sessions, were handed out during the information evening, as well.
- Information for the medical profession of Reutlingen: The first step was to contact all GPs and orthopedists by mail. Thus, they received information about the program (contents, target group, procedures), a list of frequently asked questions and information flyers to hand out to their patients. To check whether the information was received and if there were further questions, the offices were called. Additionally, all doctors of Reutlingen's network of doctors were addressed by e-mail. After a few weeks, all doctors were addressed, again via mail, by the participating health insurance services. Furthermore, the doctors' quality circle was informed about the program's availability.
- Public relations: The public was informed via various radio broadcasts and newspaper articles. In addition, Otago was advertised at events and lectures where the project team was involved.
- Accompanying evaluation: To evaluate the program, an evaluation questionnaire was handed out by the therapists at the beginning and the end of the program. Additionally, doctors and therapists were surveyed via an online questionnaire. Furthermore, the experiences gained by the therapists were collected during a focus group.
Stakeholders and their tasks
- Project team: therapist training, organization of project, evaluation
- AOK Neckar-Alb and Bosch BKK Reutlingen: sponsoring for insured people, public relations
- Physiotherapists’ and occupational therapists' offices: carrying out the Otago Exercise Program
- GPs' offices of Reutlingen: promoting the Otago Program as preventive recommendation
- Reutlingen's medical profession / Network of doctors Reutlingen: contacting doctors
- Medical supply stores: providing required weight collars
Otago Flyer (in German)
Expenses / Time
- Therapists' fee (paid by health insurance services): 241,60 Euro per completing participant (expenses for 5 home visits, including home visit flat rate and 3 calls)
- Material per patient: ca 5 Euro for binder and copies (financed by project)
- Weight collars for strength exercises: 65 Euro (paid by participant)
- Printing expenses for information flyer, newspaper advertisement
Time (for project team):
- Concept of training / training material: ca 30 h
- Training sessions: 1 day of training with 8 teaching sessions with 3 project employees
- Supporting / Consulting Otago therapists: ca 1 h per week
- Evaluation: 60 h
The Otage Exercise Program was financed in Reutlingen by two health insurance services extra budgetary (including approx. 60 % of the elderly insured people). The only way to participate in the program was if a doctor prescribed the program as a preventive recommendation. 15 physiotherapists and occupational therapists were trained to carry out the Otago Exercise Program. During the time from May 2012 and August 2013, 62 preventive recommendations were prescribed by Reutlingen's doctors - at least 47 insured people started the program.
Experiences / Advice
Participants who completed the Otago Exercise Program achieved significant improvement in the field of functionality and mobility. Most participants seemed to be able and willing to continue the exercises, so that the program's sustainability is assured.
However, the program's dropout rate was higher than expected. The reasons for these dropouts were the highly vulnerable target group on the one hand, on the other one, to motivate participants to exercise at home by themselves proved to be difficult.
To encourage motivation to exercise by themselves, it seems to be essential that
- Doctors explain all objectives and requirements of the Otago Program while prescribing it (e.g. the necessity to exercise on one's own)
- The Otago Program is not prescribed as a replacement for another therapy
- People who are not yet of restricted mobility are pointed to more demanding group offerings
- Therapists are well trained in the methodology of communication and motivation.