JMIR Publications

ABSTRACT

Background:

The Otago Program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) is unclear.

Objective:

We investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR.

Methods:

We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; Mini-Mental-Status-Test [MMST] >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP 3x/week for 20 minutes using a technology-based platform called “Pixformance”. The device is a virtual trainer and enables real-time corrections. Primary endpoint was the feasibility (given when 80% of the IG participated in six trainings within two weeks). Secondary outcomes were usability (patient´s and therapist´s perspective; ≥75%), risk of falls (Berg-Balance Scale [BBS]), mobility (Timed Up and Go Test [TUG]), functional independence (Functional Independence Measure [FIM]), and activities of daily living (Barthel Index [BI]). Several further exploratory endpoints were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire [PH-Q4]). Data were accessed at entry to EGR and after two weeks prior to discharge. To analyze the results of the pre-post-test, dependent Students´ t-test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes.

Results:

A cohort of sixty patients (80.2±6.1 years; 58% females) was analyzed. Main indication for EGR was stroke (15%). Patients were recruited into a prospective IG and a retrospective control group (CG). Of the patients in the prospective IG, eleven patients (37%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33%), pain/discomfort (33%) or fatigue (17%). EGR patients rated FFP usability at 84% and therapists at 65% out of 100%. Pre-post-test analysis of the standard assessments showed a significant interaction in BBS (<.001). In both groups, a significant improvement over time was found in TUG (<.001), BI (<.001) and FIM (<.001). Likewise, in the IG, the PH-Q4 score (.024) improved.

Conclusions:

While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility. Clinical Trial: Trial registration: German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00033558). Prospectively registered on 5 February 2024.