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Otago home exercise programme

Evidence base

The Otago exercise programme is designed specifically to prevent falls. It consists of a set of leg muscle strengthening, balance retraining exercises (progressing in difficulty) and a walking plan.

The programme was developed and tested in 4 randomised controlled trials and 1 controlled trial. It has been evaluated using meta-analysis in 1016 people aged 65-97 living at home both in the research setting and routine health services and has demonstrated effectiveness in reducing falls and injuries by 35%.

The Otago exercise programme is designed to improve strength, balance and confidence. It can be successfully delivered by a physiotherapist, nurse trained by a physiotherapist or a qualified technical/postural stability instructor.

The programme’s cost effectiveness has been established in 2 healthcare settings and is most beneficial in high risk groups (over 80, previous falls).

Delivering the programme

  • For clients who choose the Otago Programme, a postural stability instructor or rehabilitation/physiotherapy assistant will contact the client to arrange a convenient time to visit them in their own home
  • The exercises are individually prescribed and increase in difficulty during a series of four to five home visits by a trained instructor
  • Visits take place at 1 week, 2 weeks, 4 weeks and 8 weeks to teach and progress the prescribed exercises
  • Between visits, follow up telephone calls are made to check progress, advise on problems and maintain motivation
  • Each person receives a booklet with instructions for each exercise prescribed and ankle cuff weights (starting at 1kg) to provide resistance for the strengthening exercises
  • The exercises take about 30 minutes to complete. Participants are expected to exercise three times a week and go for a 30 minute walk at least twice a week
  • To help them adhere to the programme, participants record the days they complete the programme and the instructor telephones them each month between home visits.

Otago exercise programme schedule

Week 1 2 4 8  
Month   1 2 3 4 5 6
First visit to prescribe programme and explain rationale *              
Follow up visits to progress and monitor exercises   * * *        
Telephone follow up to monitor and motivate         * * *  
Optional follow up visit *             *

Criteria for referral

  • Reaction times, muscle strength or postural sway impaired related to age reflected in moderate/marked falls risk score on PPA or near tandem stand, alternate step and/or sit to stand impaired on PPA QuickScreen©
  • Able to stand unsupported on the floor with eyes open for 30 seconds
  • Able to follow commands to carry out simple motor activities
  • Memory sufficient to remember a set of exercises using the booklet as necessary
  • Motivated to exercise independently
  • Fear of falling does not limit ability to challenge balance appropriately during exercises
  • Client has chosen to participate in a home exercise programme.

Inclusion criteria

  • Fear of falling
  • Feeling unstable
  • History of falls (injurious or non-injurious)
  • Low bone density and / or family history of osteoporotic fracture.

Exclusion criteria

  • Uncontrolled angina
  • Uncontrolled resting systolic blood pressure >180mmHg or resting diastolic blood pressure >100mmHg
  • Uncontrolled tachycardia >100bpm
  • Uncontrolled acute systemic illness (cancer / pneumonia)
  • Uncontrolled visual or vestibular disturbance
  • Uncontrolled pain
  • Significant drop in blood pressure during exercise >100bpm
  • Unstable or acute heart failure
  • Unable to maintain seated upright posture due to neurological deficits
  • Impaired cognition (to the extent of being unable to follow simple movement instructions
  • People who place themselves or others at risk
  • Participants who are unable to monitor or modify their exercise level or technique or follow advice.

How to refer to home otago programme

Referrals from falls clinic

Complete the community exercise referral form and fax or send with a copy of the clinic outcome letter (sent to GP), the physiotherapy outcome sheet and the PPA results to:

Southwark

Community Falls Service
Southwark Adult Therapy Rehab Team
1st Floor
Dulwich Community Hospital
East Dulwich Grove
London SE22 8PT

Tel: 020 7525 3483
Fax: 020 8693 6760

Lambeth

Community Falls Service
Lambeth Community Care Centre
Monkton Street
London SE11 4TX

Tel: 020 3049 4004
Fax: 020 3049 4014

Non falls clinic referrals

Once the cause of the client’s falls has been investigated, complete the community exercise referral form and the specialist physiotherapy assessment form (and PPA QuickScreen© results if service has access to PPA Quickscreen) and fax or send to:

Southwark

Community Falls Service
Southwark Adult Therapy Rehab Team
1st Floor
Dulwich Community Hospital
East Dulwich Grove
London SE22 8PT

Tel: 020 7525 3483
Fax: 020 8693 6760

Lambeth

Community Falls Service
Lambeth Community Care Centre
Monkton Street
London SE11 4TX

Tel: 020 3049 4004
Fax: 020 3049 4014

Please follow this referral process to ensure clients receive the most appropriate form of treatment and are seen in a timely manner. If you are unsure about any aspect of the referral process please contact:

Southwark:

Adult Therapy Rehab Team
Phone: 020 7525 3483 or email: sou-pct.southwarkfalls@nhs.net

Lambeth:

Lambeth Community Therapies
Phone: 020 3049 4004 or email: lam-pct.lambethfalls@nhs.net