Using Motivating Reminiscence Technology to Encourage Physical Activity and Improve Balance and Mobility for Residents in Long Term Care
Phase: NA
Conditions: Adults Living in Long Term Care
Sponsor: Bruyère Health Research Institute.

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Using Motivating Reminiscence Technology to Encourage Physical Activity and Improve 
Balance and Mobility for Residents in Long Term Care. 
Bruyere REB Number: M16-19-012 
University of Ottawa REB Number: H-05-19-4462 
Ottawa Health Science Network REB Number: 20190454-01H 
ClinicalTrials.gov Identifier: NCT04043416 
 
 
 
 
 

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Project Protocol 
 
 
 
 
 
 
 
 
 
 
 
May 2019 
 
 

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1. Project Team 
 
Elizabeth Bruyère Primary Investigator: 
 
Dr. T Mark Campbell, MD 
Clinician Investigator 
Elizabeth Bruyère Hospital 
tcampbell@bruyere.org 
 
Project Lead: 
 
Susan Zorz 
Director of Resident Services 
The Glebe Centre Inc. 
SZorz@glebecentre.ca 
Ph. 613.238.2727 X 323 
Fx. 613.238.4759 
 
Co-Investigators 
 
Becky MacLeod 
Recreation Therapist 
The Glebe Centre Inc 
613-238-2727 
bmacleod@glebecentre.ca 
 
Suja Thomas 
Coordinator of Nursing Programs 
The Glebe Centre Inc 
sthomas@glebecentre.ca 
 
Sean Dellaire 
Research Associate  
The Glebe Centre Inc 
 
Kathryn L May, NP 
Nurse Practitioner 
The Ottawa Hospital 
Kmay@toh.ca 
 
Study Administration Assistant: 
Katherine Reilly 
University of Ottawa 
613-562-5800 x8238 
kreilly@ohri.ca 
 

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2. Title 
Using Motivating Reminiscence Technology to Encourage Physical Activity and Improve 
Balance and Mobility for Residents in Long Term Care. 
3. Background 
Physical activity has numerous benefits for physical well-being and function in the elderly2. 
Maintaining the functional independence of Long-Term Care (LTC) residents alleviates the ever-
increasing demands placed on front line staff. Physical activity also provides an opportunity for 
LTC residents to engage in valued activity3. However, many LTC residents rarely or never 
engage in regular physical activity due to numerous barriers such as lack of exercise equipment 
or related resources and lack of interest or motivation4. For these reasons, adults residing in LTC 
facilities  have been shown to have drastically lower physical activity levels5. Those who do 
engage in regular physical activity maintain functioning and reduce negative health outcomes 
including but not limited to deconditioning, falls and cognitive decline1. For the positive effects 
of physical activity to last, it is essential that training becomes routine, meaning that easy access 
and proximity to training opportunities as well as the provision of engaging modalities is of great 
importance.  
 
A stationary bicycle is a type of exercise equipment that resembles a bicycle without wheels and 
can engage a user in a similar way standard bicycling can. Stationary cycling is one example of a 
physical activity modality that provides opportunities for meaningful activity for LTC residents. 
Advantages of stationary cycling include limited space requirements, lower risk of harm or 
resources compared to activities such as swimming or walking outside with a population with 
dementia or mild cognitive impairment. Balance control has been shown to be less deteriorated 
for older individuals that engage in outdoor cycling activity7,8 perhaps due to an observed 
improvement in muscle strength and power with parallel increases in walking speed and other 
functional abilities9. Cycling activity is also beneficial for maintaining cognitive performance 
across multiple domains for older institutionalized individuals6. One of the challenges associated 
with stationary physical activity however is that it may be perceived as dull or disengaging. 
Novel ways to engage older adults is therefore of great importance in order to maintain a regular 
fitness program.  
 
Reminiscence is defined as inducing a vocal or silent recall of past activities, events, and 
experiences in the life of a person by using tangible prompts10, has been shown to be effective in 
improving cognitive functions while reducing depressive symptoms11. The ability to select 
specific virtual cycle trips according to the users’ wishes and memories may increase 
reminiscence for that individual and, when coupled with a stationary cycling intervention, 
increase motivation for that physical activity.  
 
The use of jDome BikeAround provides older adults in LTC an opportunity to engage in a 
motivating reminiscence activity that is coupled with physical activity that may have positive 
impact on maintaining physical and cognitive abilities thereby maintaining function and reducing 
fall risk.  
4. Rationale 
 

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One of the biggest challenges faced in LTC is to offer meaningful activities to residents. The 
jDome BikeAround system provides an ideal opportunity to explore the impact of targeted, 
specific activity interventions for people who have significant cognitive issues and other chronic 
health conditions and disabilities. This specific system has never been examined within the 
literature or any small scale published studies of the benefit of the BikeAround system, 
highlighting the need to examine this system in a controlled study. 
 
The BikeAround uses Google Street View, a stationary bike and a domed screen (Figure 1). 
Residents are seated in front of the screen; their destination is typed into the computer and when 
loaded the image appears on the screen.  Using pedals on the bike they can propel themselves 
down the street, steer and change direction as they wish.  Residents are able to visit familiar 
places anywhere in the world or travel to places they have always wanted to visit. Discussion of 
past activities, events and experiences will be aided by visited locations and conversations with 
cycle hosts (i.e. trained staff/volunteers). We will use a mixed methods approach to explore the 
feasibility and impact of our individualized, personalized structured programs.  
 
The BikeAround system is an innovative program that encourages reminiscence, physical and 
cognitive stimulation and is a fun activity that promotes positive, interactive experience.  This 
project aims to identify the physical benefits of using a jDome BikeAround reminiscence 
physical activity program for LTC residents.  
 
Figure 1: jDome BikeAround Set-up.  
Image source: https://www.camanio.com/us/products/bikearound/ 
5. Objectives 
1. Determine whether there are any effects on outcome measures of balance, 
mobility and fall risk reduction from the addition of jDome BikeAround  
2. Determine whether reminiscence is facilitated through the observation of locations 
from jDome BikeAround. 
3. Determine feasibility of integrating the technology into care on the units at the 
Glebe Centre. 
 
 
 

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6. Hypotheses 
1. Residents will have an improvement in their balance, mobility, and fall risk as 
shown by the physical outcomes due to an enjoyable interaction with the jDome 
BikeAround that stimulates reminiscence and increased physical activity for 
residence at the Glebe Centre; 
2. The reminiscence is facilitated through the observation of locations from the 
jDome BikeAround; 
3. Integrating the jDome BikeAround technology into care at the Glebe Centre is 
feasible; 
 
7. Outcomes 
Primary Outcomes 
1. Feasibility 
a. The ability to enroll 30 participants from The Glebe Centre 
b. Number of participants who completed the protocol 
c. Number of adverse events 
 
2. Physical Outcome Measures (Appendix A) 
a. Tinetti Performance-Oriented Mobility Assessment (POMA) scale 
 
Secondary Outcomes 
1. Participation (Appendix B) 
a. Sessions attended 
(Reasons for not attending scheduled sessions) 
b. Total number of sessions 
c. Total time per session 
d. Distance traveled  
e. Wong Baker Scale to evaluate satisfaction  
f. Resistance 
2. Qualitative feedback/field notes (Appendix C) 
3. Physical Outcomes 
a. Knee Range of Motion 
b. Two Minute Walk Test (TMWT) 
4. Chart Data from the CIHI quarterly reports, RAI-MDS and Activity-PRO reporting 
mechanisms. (Appendix D) 
a. Number of falls during previous year 
b. Cognitive Performance Scale (CPS) 
c. Revised Index of Social Engagement (RISE) 
 
 

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8. Methods 
1. Study Design 
 
This research project will use a cross-over pre-post study design (Appendix E) to collect mixed 
methods data for up to 30 participants. Each phase will last 6 weeks. A washout phase (phase 2) 
will allow the residents to also serve as their own comparison groups. The washout period is 
intended to allow activity levels to return to baseline between the two phases. 
2. Study population, sample selection/consent process and sample size justification 
 
The study population will consist of residents from the 254-bed Glebe Centre Residence 
(Ottawa, ON). Recruitment of the participants will commence with a notification going out 
through the Glebe Centre Newsletter. The small paragraph (Appendix F) will inform readers that 
a research project will be underway and may be appropriate for them/their resident. There will 
also be a poster put up in the main foyer to advertise the study (Appendix N). The poster was 
initially presented at the 2018 Regional Geriatric Annual General Meeting and will be 
repurposed as an advertisement tool. Contact information for the research team will be included 
if more information is required.  
 
We will aim to recruit participants of varying age groups (though participants must be ≥ 18 
years), sex/gender, and who are able to complete the outcome measures (Section 7, Outcomes).  
 
Inclusion Criteria: 
 
a. Scott fall risk of 2-17 (this is the current range used by the Glebe Centre, there have been 0 
falls during transportation to the equipment and during each session of the BikeAround 
system)  
b. Sufficient visual abilities to observe images on the domed screen 
c. Able to comprehend and communicate in English.  
d. Adequate attentional capacity to remain focused on the pedalling task. 
e. Minimum height requirement of 5’2” or 157cm in order to successfully fit the BikeAround 
system’s stationary bike.  
 
We will exclude residents with the following, as determined by the Glebe Centre healthcare 
team:  
● Physical limitations (as determined by the Glebe Centre healthcare/physiotherapy team) 
that prevent use of the jDome bike.  
● Cognitive impairment (as determined by the Glebe Centre healthcare/physiotherapy 
team) 
o Inability to sustain attention 
o Inability to follow one-step commands.  
● Known behavioural abnormalities (e.g. overly aggressive behavior) that in the opinion of 
the clinical care team might impede any meaningful participation in the project  
● Those who are in the opinion of attending physician or clinical team too unwell to 
participate in the project  
● Fully unable to complete outcome measures indicated (Section 7, Outcomes) 

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Late exclusions may occur if the resident’s condition declines after providing consent such that 
they then meet exclusion criteria. 
 
Inclusion and exclusion criteria for participation will be made known to a member of the 
resident’s primary circle of care who will inform potentially eligible residents of the opportunity 
to participate in the study. This staff member will ask if the resident would like to provide 
contact information to a member of the research team (who will not be a part of the primary 
circle of care) for the purpose of discussing study participation in more detail (see Recruitment 
Script for Staff; Appendix G). Agreement to discuss the project with a research team member 
will be documented on the patient’s chart. In the event that the investigators are part of the 
resident’s circle of care, they will neither be recruiting participants nor obtaining consent.  
 
If the resident agrees to provide their name and room number, the member of the circle of care 
will forward the resident name and room number to the research assistant (RA) in a secure 
manner via password-protected voicemail and/or encrypted email. The RA will then visit the 
resident in-person (visit #1) on the unit to discuss the project (using Recruitment Script for RA; 
Appendix H) and obtain informed consent in-person (Appendix I). Potential participants and/or 
substitute decision-makers will be given an opportunity to read the consent form, ask questions 
and will be provided adequate time to make their decision. 
 
Residents that are identified by the staff as being potential participants, but do not have the 
capacity to provide informed consent will not be excluded. If they are eligible but unable to 
provide informed consent (that is, they have a substitute decision-maker for their medical care), 
the substitute decision maker (SDM) will be contacted. The SDM on file will be contacted by a 
member of the resident’s healthcare team and will be asked for verbal or written (via email) 
consent to provide contact information to the research team if they express interest in more 
information about their resident’s participation in the study. A member of the research team will 
then call the SDM to obtain informed consent (Appendix J) for their resident. An option for the 
SDM to return their consent to participate in the research study either verbally or over email as it 
is possible that some will not be able to scan and send a signed consent form. 
 
As per the Partnership of Consent Protocol12, after the SDM provides informed consent for the 
resident, assent is still required from the resident. If the resident provides no signs of dissent 
(shrieking, repetitive verbalizations, facial grimacing, hand wringing, or rocking movements), 
then the resident will be included in the study. However, if the resident shows signs of dissent, 
the behaviours will be verified with the LTC staff.  If these signs are at baseline for that resident, 
it can be considered assent and the resident will be included. If the behaviours are not at baseline, 
the RA will wait 24 hours and try to approach the resident again. If the resident shows signs of 
dissent not at baseline for a second time, the resident will be excluded from participation in the 
study.  
 
It is important that the patient also demonstrates assent for each jDome BikeAround session. 
Timing of each session will be optimized for each participant’s daily schedule and activity 
performance. If the patient shows no signs of dissent before and during each jDome BikeAround 
session the session will continue. If the patient does show signs of dissent, or exhibits behaviour 
suggesting they are no longer willing to participate,the session will be ended. . The patient will 

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be approached for another session 24 hours later, if the patient shows signs of dissent during the 
second attempt at a jDome BikeAround session that session will be halted and the patient will be 
withdrawn from the study.  
 
Sample Size  
 
Sample size will be based upon our primary feasibility outcome. At the Glebe LTC, 
approximately 50 residents use the jDome BikeAround System annually. We estimate that over 
the course of the study timeframe that ~40% of these residents will be unavailable to participate. 
Thus, we expect to recruit 30 participants into the study. It should be noted that there are no other 
studies running at The Glebe Centre at the moment. Those that currently use the BikeAround 
system can be recruited into the study, but will undergo at least a 4-week washout period (no use 
of the system) prior to their initial participation in the study. 
3. Methods and procedures for data collection and analysis 
ii. 
Data Collection 
All participants will be assessed with the physical outcome measures (Section 7) prior to the 
commencement of the intervention (phase 1) as well as after each phase (total of 4 outcome 
measure time points, see Appendix E). Physical outcome measures will be done by a member of 
the physiotherapy team who will be blinded to the participants’ current phase. Each measurement 
session is expected to take approximately 20 minutes and will include the POMA, 2MWT and 
knee ROM.  Hard-copy versions of the all the data forms will not use resident identifiers but will 
instead use research team allocated study-specific identifiers that cannot be linked back to the 
participant (e.g. P01). All hard copies of study data will be kept in the physio team’s locked 
office within a locked filing cabinet. All electronic and hard copies of study data will be 
destroyed and/or shredded 10 years after the culmination of the study. The masterlist that 
connects the study specific identifiers to the participants will be stored separately in a password-
protected file on the Glebe’s secure server. 
 
Following the completion of pre-intervention outcome measures, the participants will be 
randomized into one of two possible groups Residents will either participate in the intervention 
during phase 1 or be delayed until phase 3. Due to the nature of the cross-over design, it is 
possible that participants will identify their group allocation (e.g. if their use of the jDome 
BikeAround System is delayed). This may result in performance bias, and is a limitation of our 
protocol. The physiotherapy team performing the outcome measures will be blinded to the group 
allocation, reducing the likelihood of detection bias. As per the standard of care all the patients 
will be participating in the ‘fall prevention program’ throughout all phases of the protocol. The 
standard fall prevention program involves reducing the incidence of residents’ falls and 
mitigating risks of falls through a resident focused, team approach which ensures that a 
resident’s environment and social, physical, cognitive and emotional strengths are supported. A 
more in-depth summary of the program can be found in Appendix L.  
 
Data extraction of chart data will be completed by a research associate using a de-identified 
Microsoft Excel spreadsheet saved on the secure Glebe Centre server. A password-protected 
master list saved on the secure Glebe Centre server will contain resident identifying information 
and study identification codes and will be updated throughout the course of the study (Appendix 
K).  

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Personal health information extracted from the charts for the purposes of the study will include: 
 
a) Age 
b) Sex (Male, Female, or Other) 
c) Height 
d) Weight 
e) Medical diagnoses 
f) List of medications 
g) Cognitive Performance Scale score 
h) Revised Index of Social Engagement (RISE) score 
i) ActivityPro data 
 
ii. Analysis 
 
Qualitative Analysis 
Qualitative field notes will be de-identified and imported into NVivo 11, a qualitative software 
program. Transcripts and field notes will be reviewed and coded using an iterative content 
analysis approach. Themes and sub-themes across transcripts will be identified using NVivo.  
 
Quantitative Analysis 
We will determine the success of the primary outcome of feasibility as follows: 1) We are able to 
recruit 30 participants into the study; 2) Less than 15% of participants will be unable to complete 
the study; 3) There are no serious adverse events, defined as (i) major change in medical 
condition, injury, or intractable dizziness ± nausea related to the use of the jDome BikeAround 
System, (ii) severe emotional distress necessitating cessation of use of the jDome BikeAround 
System, (iii) falls either during transport to and from, or while using the jDome BikeAround 
System. 
 
Regarding the primary physical outcome, POMA, we do not have data upon which to perform a 
power analysis for this part of the study, thus we are unable to set specific thresholds for success 
based on our available sample size.  
 
All quantitative data (e.g. physical outcomes, participation data) will be analyzed using SPSS 
software with an α of 0.05. Data will be analyzed to determine normality and appropriate 
statistical tests will be used to determine intergroup differences. Continuous data will be 
evaluated using methods such as student’s t-test, categorical data will be evaluated using chi-
squared. 
 
Analysis Location 
All de-identified data will be entered into excel databases. This data will be transported on an 
encrypted external hard drive to the University of Ottawa where it will be stored on the Campbell 
Laboratory server space for data analysis. The data being transferred will not include the master 
list that connects study identifiers to individual participants and the data will only be transferred 
after the study intervention is complete. 
 

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4. Intervention details  
In collaboration with the healthcare team and the residents, cycling sessions will be scheduled to 
provide consistency for the residents. A goal of 3 sessions every week will be attempted, this is 
the number of sessions attempted during regular implementation at the Glebe Centre. Each 
session will be facilitated by a “Cycle Host”. A cycle host is either a trained staff or volunteer at 
the Glebe Centre. All Cycle Hosts will be required to undergo a 1-hour training session to ensure 
consistency between hosts and safety of the residents as well as how to assess whether the 
patients are giving ongoing consent. They may also provide basic technical support. The RA will 
also work closely with the participant’s circle of care to ensure that the patients continue to meet 
the inclusion criteria. The cycle host will find the resident and bring them to the BikeAround and 
escort them back to their room following the session. The length of each BikeAround session 
will be at the participant’s discretion provided the cycle host (research associate/volunteer) deem 
it safe and it does not exceed 30 minutes in one session, a common participation duration for 
current Glebe LTC resident users.  
 
The jDome BikeAround sessions involve the use of Google Street View, a stationary bike and a 
domed screen.  Residents are seated comfortably in front of the screen; their destination is typed 
into the computer and when loaded the image appears on the screen.  Using pedals on the bike 
they can propel themselves down the street, steer and change direction as they wish.  Residents 
are able to visit familiar places of their choosing anywhere in the world or travel to places they 
have always wanted to visit.  As long as it has been mapped by Google, it can be displayed on 
the domed screen. Google StreetView covers 39 countries and approximately 3000 cities. Each 
session the participants have the option to pick their location, or the cyclehost can pick from pre-
selected locations given by families and/or SDMs of the participants. 
 
9. Risks/Benefits 
 
We predict that there are minimal risks involved in participation in this study, though there is a 
chance of emotional distress being triggered by reminiscences. In the event that a participant 
begins to show signs of severe emotional distress, participation will be stopped immediately at 
the participant’s request, and clinical chaplains and social workers will be available on the unit 
and contacted as soon as possible. The resident’s attending physician and nurse will also be 
notified of any emotional distress caused as a result of this project.  
 
It should be noted that with the regular use of the BikeAround system at the Glebe Centre over 
the last 12 months. During this time period there have been hundreds of sessions with over 50 
residents have used the equipment multiple times per week. Only  where 3 residents experienced 
adverse events during one of their sessions. All of them being that the resident felt dizzy during 
the session due to the speed the bike was appearing to be going on the screen. These adverse 
events have been resolved by changing the parameters of the jDome BikeAround session, where 
the speed of the video aspect is slowed and not dependent on the speed the participant is 
pedaling. The highest resident’s Scott Fall Risk that has used the system in the past was 17, and 
there were no serious adverse events experienced. 
 
 

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Benefits to the residents may be limited to interaction with the jDome BikeAround with possible 
improvements to their balance and mobility. Increased social and psychological well-being may 
be possible as enjoyable reminiscence through videos/pictures have been shown to be a positive 
experience for individuals with dementia.  
10. Timelines 
 
September – December 2018 
Protocol and REB application development and submission 
December 2018 – February 2019 
REB approval / liaison with REB to obtain approval 
February - July 2019 
Participant recruitment and data collection 
July – September 2019 
Data analysis, synthesis of final report of findings 
11. Potential Conflicts of Interest 
The Glebe Centre is receiving financial payment from the Canadian Aging and Brain Health 
Innovation (CABHI) to cover the cost of conducting this study. 
12. Contingency Planning 
In the event of an epidemic, pandemic, or similar emergency situation where the research staff 
would not have access to the research participants the participants would not participate in the 
BikeAround system during that period. This would not affect the overall health of the 
participants since they will still be receiving the standard of care provided by staff at The Glebe 
Centre and would be cared for following the Glebe Centre’s standard operating procedures 
during emergency situations. 
13. Budget 
See Appendix K 
14. Publication and Dissemination of Results 
The results of this study will be published in a peer-review journal and presented at national and 
international conferences. A summary of the results will also be included in the Glebe Centre’s 
Newsletter, which will also be disseminated directly to the study participants. 
 
15. Troubleshooting 
Although highly unlikely due to the large available participant pool to draw from, in the case that 
not enough participants are available for recruitment, the information gathered will still be of use 
as this is the first research project on the use of the jDome BikeAround system for residents in 
long term care. The smaller sample size will impact the strength of significance but still provide 
a platform for future research.   
16. References 
 
1.  
Lautenschlager NT, Cox K, Kurz AF. Physical Activity and Mild Cognitive Impairment 
and Alzheimer’s Disease. Curr. Neurol. Neurosci. Rep. [Internet]. 2010;10:352–8. 
Available from: http://link.springer.com/10.1007/s11910-010-0121-7 
2.  
Vogel T, Brechat P-H, Leprêtre P-M, Kaltenbach G, Berthel M, Lonsdorfer J. Health 

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benefits of physical activity in older patients: a review. Int. J. Clin. Pract. [Internet]. 
2009;63:303–20. Available from: http://doi.wiley.com/10.1111/j.1742-1241.2008.01957.x 
3.  
Menne HL, Johnson JD, Whitlatch CJ, Schwartz SM. Activity Preferences of Persons 
With Dementia. Act. Adapt. Aging. 2012;36:195–213.  
4.  
Benjamin K, Edwards N, Ploeg J, Legault F. Barriers to physical activity and restorative 
care for residents in long-term care: a review of the literature. J. Aging Phys. Act. 
[Internet]. 2014;22:154–65. Available from: http://0-
search.ebscohost.com.library.ucc.ie/login.aspx?direct=true&db=rzh&AN=107880169&sit
e=ehost-live%5Cn10.1123/JAPA:2012-0139%5Cnhttp://0-
search.ebscohost.com.library.ucc.ie/login.aspx?direct=true&db=ssf&AN=93710219&site
=ehost-live 
5.  
de Hollander EL, Proper KI. Physical activity levels of adults with various physical 
disabilities. Prev. Med. reports [Internet]. 2018;10:370–6. Available from: 
https://doi.org/10.1016/j.pmedr.2018.04.017 
6.  
Varela S, Cancela JM, Seijo-Martinez M, Ayán C. Self-Paced Cycling Improves 
Cognition on Institutionalized Older Adults Without Known Cognitive Impairment: A 15-
Month Randomized Controlled Trial. J. Aging Phys. Act. [Internet]. 2018;26:614–23. 
Available from: https://journals.humankinetics.com/doi/10.1123/japa.2017-0135 
7.  
Batcir S, Melzer I. Daily Bicycling in Older Adults May be Effective to Reduce Fall 
Risks—A Case-Control Study. J. Aging Phys. Act. [Internet]. 2018;26:570–6. Available 
from: http://journals.humankinetics.com/doi/10.1123/japa.2017-0263 
8.  
Harvey S, Rissel C, Pijnappels M. Associations Between Bicycling and Reduced Fall-
Related Physical Performance in Older Adults. J. Aging Phys. Act. [Internet]. 
2018;26:514–9. Available from: 
http://journals.humankinetics.com/doi/10.1123/japa.2017-0243 
9.  
Macaluso A, Young A, Gibb KS, Rowe DA, De Vito G. Cycling as a novel approach to 
resistance training increases muscle strength, power, and selected functional abilities in 
healthy older women. J. Appl. Physiol. [Internet]. 2003;95:2544–53. Available from: 
http://www.ncbi.nlm.nih.gov/pubmed/12937026 
10.  
Huang H, Chen Y, Chen P. Reminiscence Therapy Improves Cognitive Functions and 
Reduces Depressive Symptoms in Elderly People With Dementia : A Meta-Analysis of 
Randomized Controlled Trials. J. Am. Med. Dir. Assoc. [Internet]. 2015;16:1087–94. 
Available from: http://dx.doi.org/10.1016/j.jamda.2015.07.010 
11. 
Karssemeijer EGA, Aaronson JA, Bossers WJ, Smits T, Olde Rikkert MGM, Kessels 
RPC. Positive effects of combined cognitive and physical exercise training on cognitive 
function in older adults with mild cognitive impairment or dementia: A meta-analysis. 
Ageing Res Rev. [Internet]. 2017; 40:75-83. Available from: 
https://www.sciencedirect.com/science/article/pii/S1568163717301149?via%3Dihub 
12.  
Batchelor-Aselage M, Amella E, Zapka J, Mueller M, Beck C. Research with dementia 
patients in the nursing home setting: a protocol for informed consent and assent. IRB 
[Internet]. 2014;36:14–20. Available from: 
http://www.ncbi.nlm.nih.gov/pubmed/24783377 
 
 
 
 
 

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17. Appendices 
 
Appendix A – Physical Outcome Measures (Primary and Secondary) 
Appendix B – Participation Log 
Appendix C – Field Note Page 
Appendix D – Medical Chart Data Outcome Extraction Sheet 
Appendix E – Cross-over Study Design Diagram 
Appendix F – Newsletter Paragraph 
Appendix G – Recruitment Script for Staff 
Appendix H – Recruitment Script For RA 
Appendix I – Participant Consent Form 
Appendix J – SDM Participant Consent Form 
Appendix K – Master List Sheet 
Appendix L – CABHI Budget 
Appendix M – Summary of Fall Prevention Program at The Glebe Centre 
Appendix N – Poster for presentation in main foyer 
 
 
 

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Appendix A: Physical Outcomes 
17.1.1 Demographic sheet 
 
Item 
Value 
Participant Number 
 
Gender 
 
D.O.B 
(dd-mm-yyyy) 
 
Height (m) 
 
Weight (kg) 
 
Scott Fall Risk 
 
Number of falls in the past 
year 
 
Gait Aid Used (Y/N) 
 
 
 
 

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17.1.2 The Tinetti Test (Performance Oriented Mobility Assessment (POMA)) 
 
DESCRIPTION  
The Tinetti Assessment Tool is a simple, easily administered test that measures a resident’s gait 
and balance. The test is scored on the resident’s ability to perform specific tasks. 
 
TIME TO COMPLETE 
10 to 15 minutes 
 
SCORING 
Scoring of the Tinetti Assessment Tool is done on a three-point ordinal scale with a range of 0 to 
2.  A score of 0 represents the most impairment, while a score of 2 represents independence.  The 
individual scores are then combined to form three measures; an overall gait assessment score, 
and overall balance assessment score, ad a combined gait and balance score. 
 
INTERPRETATION 
The maximum score for the gait component is 12 points.  The maximum score for the balance 
component is 16 points.  The maximum total score is 28 points. IN general, residents who score 
below 19 are at a high risk for falls.  Residents who score in the range of 19 – 24 points indicate 
that the resident has a risk for falls. 
 
RELIABILITY 
Interrater reliability was measured in a study of 15 residents by having a physician and a nurse 
test the residents at the same time.  Agreement was found on over 85% of the time and the items 
that differed never did so by more than 10%.  These results indicate that the Tinetti Assessment 
Tool has good interrater reliability. 
 
VALIDITY 
The Tinetti POMA test has been determined to be a valid test in elderly populations amongst 
other populations and those with mild to moderate dementia. 
REFERENCES 
Lewis C. Balance, Gait Test Proves Simple Yet Useful.  P.T. Bulletin, 1993; 2/10:9 & 40 
 Tinetti ME.  Performance-oriented Assessment of Mobility Problems in Elderly Patients.  J Am 
Geriatr Soc 1986; 34:119-126. 
 
Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on number of 
chronic disabilities. Am J Med 1986:80:429-434 
 
Cipriany-Dacko LM, Innerst D, Johannsen J. Interrater reliability of tinetty balance scores in 
novice and experienced physical therapy clinicians. Arch Phys Med Rehabil. 1997; 78(10): 
1160-1164 
 
Tooper AK, Maki BE, Holliday PJ. Are activity-based assessments of balance and gait in the 
elderly predictive of risk of falls and/or type of fall? J Am Geriatr Soc 1993; 41: 479-487 
 
Kegelmeyer DA, Kloos AD, Thomas KM, Kostyk SK. Reliability and validity of the tinettu 
mobility test of individuals with Parkinson Disease. Phys Ther 2007: 87(10): 1369-1378. 

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Participant Number:   ______________________  Date:  ______________________ 
Evaluator:  ______________________ 
POMA BALANCE SECTION 
 Resident is seated in hard, armless chair; 
TASK 
DESCRIPTION 
SCORE (0-2) 
1.  SITTING BALANCE 
Leans or slides in chair 
 
Steady, safe 
 
2.  RISES FROM CHAIR 
Unable without help 
 
Able, uses arms to help up 
 
Able without using arms 
 
3.  ATTEMPTS TO RISE  
FROM CHAIR 
Unable without help 
 
Able, requires > 1 attempt 
 
Able to rise in 1 attempt 
 
4.  IMMEDIATE  
STANDING BALANCE 
(first 5 seconds) 
Unsteady (swaggers, moves feet, trunk sways) 
 
Steady but uses walker or other support 
 
Steady without walker or other support 
 
5.  STANDING  
BALANCE 
Unsteady 
 
Steady but wide stance (heels 4 inches apart) 
 and uses cane or other support 
 
Narrows stance without support 
 
6.  NUDGED (subject 
at max position with 
feet as close together 
as possible, examiner 
pushes lightly on  
subject’s sternum with 
palm of hand 3 times) 
Begins to fall 
 
Staggers, grabs, catches self 
 
Steady 
 
7.  EYES CLOSED (at 
max position – see #6) 
Unsteady 
 
Steady 
 
8.  TURNING 360  
DEGREES 
Discontinuous steps 
 
Continuous steps 
 
Unsteady (grabs, swaggers) 
 
Steady 
 
9.  SITTING DOWN 
Unsafe (misjudged distance, falls into chair) 
 
Uses arms or not a smooth motion 
 
Safe, smooth motion 
 
Total Balance Score 
 

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POMA GAIT SECTION 
 
Initial Instructions: Subject stands with examiner, walks down the hallway or across the room, first at “usual” 
pace, then back at “rapid but safe” pace.  Use usual walking aid. 
 
TASK 
DESCRIPTION 
SCORE (0-2) 
10. INITIATION  
F GAIT 
(immediately after told 
to “go) 
Any hesitancy or multiple attempts to start 
 
No hesitancy 
 
11.  STEP LENGTH 
AND HEIGHT 
RIGHT swing food does not pass left stance foot  
with step 
 
RIGHT foot passes left stance foot 
 
RIGHT foot does not clear floor completely  
with step 
 
RIGHT foot completely clears floor 
 
LEFT swing foot does not pass right stance foot  
with step 
 
LEFT foot passes right stance foot 
 
LEFT foot does not clear floor completely 
 with step 
 
LEFT foot completely clears floor 
 
12.  STEP 
SYMMETRY 
RIGHT AND LEFT step length not equal-estimate.  
RIGHT AND LEFT step appear equal 
 
13.   STEP  
CONTINUITY 
Stopping or discontinuity between steps 
 
Steps appear to continue 
 
14.  PATH (estimated 
in relation to floor tiles,  
12-inch diameter.  
Observe excursion of 1 
foot over about 10 feet 
of the course) 
Marked deviation 
 
Mild/moderate deviation or uses walking aid 
 
Straight without walking aid  
 
15.  TRUNK 
Marked sway or uses walking aid 
 
No sway – but flexion of knees or back, 
or spreads arms out while walking 
 
No sway, no flexion, no use of arms,  
and no use of walking aid 
 
16.  WALKING STANCE Heels apart 
 
Heels almost touching while walking 
 
Total Gait Score 
 

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POMA SORING SECTION 
Score – Balance 
       /16 
Score – Gait 
      /12 
Score – Total 
      /28 
 
 
Assessor Signature & Title: ____________________________________________ 
 
Location During Assessment: ___________________________________________ 
 
Risk Indicators: 
 
≤18 High 
 
 
19-23 Moderate 
 
≥24 Low 
 
 
 
 
 
 

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17.1.3: Two Minute Walk Test (TMWT) 
 
Two Minute Walk Test 
 
General Information:  
 
✓ Individual walks without assistance for 2 minutes and the distance is measured from the start 
of timing when the individual is instructed to “Go”  
✓ Stop timing at exactly 2 minutes  
✓ Assistive devices can be used but should be kept consistent and documented from test to test  
o If physical assistance is required to walk, this should not be performed  
✓ A measuring wheel is helpful to determine distance walked should be performed at the fastest 
speed possible  
 
Set-up and equipment:  
✓ A measuring wheel is helpful to determine distance walked should be performed at the fastest 
speed possible  
✓ Ensure the hallway free of obstacles  
✓ Functioning stopwatch ready. 
 
Participant Instructions  
 
“Cover as much ground as possible over 2 minutes. Walk continuously if possible, but do not be 
concerned if you need to slow down or stop to rest. The goal is to feel at the end of the test that more 
ground could not have been covered in the two minutes.” 
 
Minimal Detectable Change (MDC) – 12.2m (90% Confidence)1 
Normative Data (LTC) – 77.5m (±25.6) 
 
 

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Two Minute Walk Test (TMWT) 
 
Participant Number:  ______________________   
Date:  ______________________ 
 
Evaluator: ______________________ 
“Cover as much ground as possible over 2 minutes. Walk continuously if possible, but do not be 
concerned if you need to slow down or stop to rest. The goal is to feel at the end of the test that more 
ground could not have been covered in the two minutes.” 
 
 
Distance Walked: ______________________ (metres) 
 
 
 
Gait Aid Used?  
YES 
 
 
NO 
 
 
 
If yes, what was used: ____________________________________________ 
 
 
Notes: 
 
 
 
 
 
 
 
 
 
 
Assessor Signature & Title: ____________________________________________ 
 
Location During Assessment: ___________________________________________ 
 
 

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17.1.4: Knee Range of Motion (ROM) 
 
Knee Range of Motion Test (ROM) 
 
Description:  
 
Assess the range of motion of the patient’s knees. 
 
Equipment:  
 
Examination bed, goniometer, rolled towel 
 
Therapist Instructions: 
 
Knee Extension: 
-Have the patients placed in supine position, hips at neutral and  
with the knee in extension 
 
-A rolled towel is placed under the calcaneus to maximize knee 
extension 
 
-The goniometer’s fulcrum is centered over the lateral condyle of 
the femur. The arms are aligned with the greater trochanter and 
lateral malleolus. 
 
-The angle formed by these landmarks was the maximal angle of 
extension 
 
Knee Flexion: 
-The patient lifts their leg off of the towel and places their foot flat  
on the examination table. The patient brings their foot as close as  
possible toward their hip closing the angle of their knee as much as  
possible. 
- The goniometer’s fulcrum is centered over the lateral condyle of 
the femur. The arms are aligned with the greater trochanter and 
lateral malleolus. 
 
-The angle formed by these landmarks was the maximal angle of 
flexion 
 
-The patient might need assistance, aid as necessary 
 
Resident Instructions: 
-Please lie on this bed and place your ankle on this towel and 
extend your knee as much as possible 
 
-I’m just going to find a portion of your hip 
 
-Now, if you could bend your knee, bring your foot as close as you 
can to your hip and keep your foot flat on the table. 
 
References 
Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 3rd ed. 
Philadelphia: FA Davis Company; 2003. 
 
 

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Knee Range of Motion (ROM) 
 
 
Participant Number:  ______________________   
Date:  ______________________ 
 
Evaluator: ______________________ 
 
 
 
Max extension left knee: 
 
Max flexion left knee: 
 
 
Max extension right knee: 
 
Max flexion right knee: 
 
 
Assessor Signature & Title: ____________________________________________ 
 
Location During Assessment: ___________________________________________ 
 
 

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Appendix B: Participation Outcomes 
17.2.1: BikeAround Session Evaluation 
Bike Around Session Evaluation 
Participant Number: ______________________________________ 
 
 
Date 
Baseline 
Mood (#) 
Baseline 
Time 
Follow Up 
Mood (#) 
Follow 
Up Time 
Distance 
Travelled (KM) 
Pedometer 
Time 
Who Facilitated?  
 
  
  
  
  
 
 
  
 
Level of resistance (please circle) → 0 
1 
2 
3 
4 
5 
6 
7 
8 
 
 
 
10 
20 
30 
 
Interest 
Interest in others (staff, cycle hosts, etc.) 
 
 
 
Without prompts offers support of a peer 
 
 
 
Acknowledges support from a peer 
 
 
 
 
Attention 
While engaged sustains attention 
 
 
 
Requires verbal prompting or cueing 
 
 
 
Initiates or engages in conversation 
 
 
 
Pleasure 
Relaxed body language, smiles, and laughs 
 
 
 
Verbalizes sense of pleasure 
 
 
 
 
Negative Affect 
Anger 
 
 
 
Physical signs of agitation 
 
 
 
Verbalizes feeling anxious 
 
 
 
Sadness 
Behavioral signs of sadness 
 
 
 
Verbalizes feeling sad 
 
 
 
 
Self Esteem 
Non-verbal expression of pride 
 
 
 
Verbal expression of satisfaction 
 
 
 
Inferred prideful reminiscence 
 
 
 
 
Normalcy 
Verbal expression of normalcy 
 
 
 
Non-verbal expression of social normalcy 
 
 
 
When joining or leaving, interacts with others 
 
 
 
 
4- Always  
3- Most of the time  
2- Some of the time  
1- Rarely  
0 – Never 
 
Resident expresses an interest to continue with program 
 
Yes  
 
No  
What seating adjustments were made for the resident? 
____________________________________________________________________________ 
What location did the resident visit? 

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Resident Refusal Form 
Please mark Resident on this list if they were; 
 
- 
(A) Absent from participation  
(i.e. Out with family, in another program, in shower, etc.) 
OR 
- 
(C) Chose to not participate on a day when they were scheduled  
(i.e. They verbally told you they didn’t want to participate) 
OR 
- 
(SL) Sleeping 
(i.e. Unable to wake up or too drowsy) 
OR 
- 
(S) Sick 
(i.e.  they were not feeling well, or a nursing staff mentioned they were not feeling well)  
 
Date 
Time of Day 
Participant 
Number 
Resident Reason 
Volunteer 
Name 
June 1st 
11:00am 
PN22 
(C) 
Didn’t want to come 
Becky 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EX. 

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Appendix C: Field Notes - Qualitative Outcome 
 
 
Participant ID: _________________________________ 
 
 
Date: 
 
 
Time: 
 
Observations: (If completing these forms during the activity sessions, this form can include things 
like discussions that participants are having with others, including research staff or other staff; 
changes in behaviour or mood; location selection, if applicable; and so on. Always ask participants 
at the start of a session if field notes can be taken.) 
 
 
The location the participant went: 
 
 
Did the participant pick this location (Circle): Yes     No 
 
Was there a change in the participant’s mood (Circle): Yes    No 
 
 
Please Describe this change: 
 
 
 
 
 
 
 
 
Other observations: 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Appendix D: Medical Chart Data Outcome Extraction Sheet 
 
Participant Number:  ______________________  
Date:  ______________________ 
 
Chart Reviewer: ______________________ 
CPS Score 
The Cognitive Performance Scale (CPS) combines information on memory impairment, 
level of consciousness, and executive function, with scores ranging from 0 (intact) to 6 (very 
severe impairment). The CPS has been shown to be highly correlated with the MMSE in several 
validation studies. 
 
Morris JN, Fries BE, Mehr DR, Hawes C, Philips C, Mor V, Lipsitz L. (1994) MDS Cognitive Performance Scale. 
Journal of Gerontology: Medical Sciences 49 (4): M174-M182. 
 
SCORE 
Date Evaluated 
Notes 
 
 
 
 
 
 
 
 
 
 
Revised Index of Social Engagement (RISE) 
The Revised Index of Social Engagement (RISE) is a measure of social engagement based 
on being at ease interacting with others, being at ease doing planned activities, accepting 
invitations, pursuing involvement in life of facility, initiating interactions and reacting positively 
to interactions. Scale scores range from 0-6 with higher scores indicative of greater social 
engagement in the life of the facility. The index is a revised version of the Index of Social 
Engagement (ISE) that was developed for an earlier version of the RAI for long term care 
facilities. 
SCORE 
Date Evaluated 
Notes 
 
 
 
 
 
 
 
 
 
 
 
 

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Participant Number:  ______________________  
Date:  ______________________ 
 
Chart Reviewer: ______________________ 
 
 
Current Medication list: 
Compile a list of all of the medications each participant is on (both amount and frequency) 
 
Medication Name 
Dosage information 
 
 
 
 
 
 
 
 

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Activity Pro Data 
Extraction Sheet 
 
 
 
 
 
 
Participant Number: 
 
 
Project Phase: 
 
 
Date Range: 
 
 
Overall Engagement Score: 
 
 
Self-Directed Score: 
 
 
Total Minutes of Engagement: 
 
 
Number of Activity Participations: 
 
 
 
Category 
Total Number 
Notes 
C (Chose not to attend) 
 
 
S (Sick) 
 
 
SL (Sleeping) 
 
 
A (Absent) 
 
 
 
 
 
 
Data Extracted By: 
 
 
Date: 
 
 

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Appendix E: Cross-Over Study Design Diagram 
 

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Appendix F: Newsletter Paragraph 
 
The Glebe Centre, in partnership with the University of Ottawa and Bruyère Research Institute, 
is excited to begin recruitment for a research project that will provide residents with an 
opportunity to engage in a cycling (stationary) activity that is combined with a virtual trip to 
anywhere Google Maps have been…anywhere around the world. These virtual images may help 
engage and immerse residents into the activity. We are looking to observe how residents engage 
in this activity and whether it can improve their balance and mobility. Whether your resident has 
participated in this activity before or not, feel free to contact Susan Zorz at 
SZorz@glebecentre.ca or 613.238.2727 X 323 for more information. 
 

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Appendix G: Recruitment Script for Staff 
 
When discussing with the resident:  
 
LTC Staff:  
“I would like to let you know that there is a research project underway here at The Glebe Centre 
that you may be eligible for. Your decision to hear more about this project will not impact the 
care you receive here at The Glebe Centre. It is completely voluntary, and you have the right to 
stop participation at any time. Would you like to hear more about this research project?” 
If YES:  
“Wonderful, thank you! Can I have your verbal consent to pass your information to a member of 
the research team? They will come by to see you in a few days to provide you more information 
about this project.” 
If NO:  
“No problem at all. Again, this does not impact the care that you receive here at The Glebe 
Centre.” 
If questions arise regarding this project: 
“As I am not directly involved with this research project, I would have to defer you to the 
research team to have your questions answered.”  
 
 
 
When calling the SDM: 
 
**After confirming you are talking to the SDM for the resident: 
 
LTC Staff:  
“I would like to let you know that there is a research project underway at The Glebe Centre  
that___________(insert name here)_________is in. Your decision to hear more about this 
project will not impact the care they receive here at The Glebe Centre. It is completely voluntary, 
and they have the right to stop participation at any time. Would you like to hear more about this 
research project?” 
If YES:  
“Wonderful, thank you! Can I have your verbal consent to pass your contact information to a 
member of the research team? They will contact you in a few days to provide you more 
information about this project.” 
If NO:  
“No problem at all. Again, this does not impact the care that___________(insert name 
here)_________ receives here at The Glebe Centre.” 
If questions arise regarding this project: 
“As I am not directly involved with this research project, I would have to defer you to the 
research team to have your questions answered.”  
 
When emailing the SDM 
 
**After confirming you are using the email on file for the SDM: 
 

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LTC Staff:  
Hello ____(Insert name of SDM), 
 
“I would like to let you know that there is a research project underway at The Glebe Centre  
that___________(insert first name here of resident)_____is in. Your decision to hear more about 
this project will not impact the care they receive here at The Glebe Centre. It is completely 
voluntary, and they have the right to stop participation at any time. If you would like to hear 
more about this research project please reply to this email and a member of the research team 
will contact you in a few days to provide more information.  
 
Sincerely, 
 
(insert your name) 
 
 
If YES reply:  
“Wonderful, thank you! They will contact you in a few days to provide you more information 
about this project.” 
If NO reply:  
“No problem at all. Again, this does not impact the care that___________(insert name 
here)_________ receives here at The Glebe Centre.” 
If questions arise regarding this project: 
“As I am not directly involved with this research project, I would have to defer you to the 
research team to have your questions answered.”  
 
 
 
 

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Appendix H: Recruitment Script for RA 
 
1. Introduction of Research Team Member to SDM/POA: 
“Good morning/ Good afternoon/ Good evening Mrs./Mr./Ms._____________________. My 
name is ____________________.  I’m one of the researchers for an activity study 
happening at The Glebe Centre that _____________________ mentioned to you, and 
indicated to me that your loved one might be interested in participating”. 
 
2. Introducing the Study 
“This study involves your loved one using a stationary bike while supervised during their daily 
activities. This bike is safe and effective for encouraging increased activity for older 
adults. This is not a real exercise bike, but rather a modified version that your loved one 
will sit on his own chair and use their arms and legs to engage in activity. This study will 
go for 18 weeks. Your loved one will either have the opportunity to use this bike for the 
first 6 weeks or delayed to the second group during the last 6 weeks. Whichever group 
they are randomized to, they will have the opportunity to participate. During these 
sessions, your loved one will be helped to the bike by myself, a volunteer, a recreation 
therapist or a staff member on the unit. Their participation is optional every day. During 
their pedalling, they will be immersed into a large dome that can display images 
captured on Google Street View. They can select where in the world they would like to 
pedal with help from the cycle host. If you decided to allow your loved one to participate, 
we would love to have your help to create a list of fun places for them to visit. Our hope 
is that residents who participate in this program will experience overall improvements in 
their quality of life.” 
 
3. Consent 
“Would you be interested in having your loved one participate in this project?”  (If yes, proceed 
to #4 If no, proceed to #5a). 
 
4. Follow-Up for Written or Oral Informed Consent 
“When might be the next time you’ll be visiting The Glebe Centre, in order for one of the 
researchers to meet with you to read and sign the full Informed Consent form?  
Alternatively, we can record your oral consent for your loved one to participate and send 
you the form electronically for your information.”  
*(Also give option to send form electronically first, and then follow-up with another phone call 
for oral consent if the SDM/POA prefers). 
**Note, the researcher will also have the Informed Consent form nearby in order to answer any 
other questions directly from the information provided in the form *** 
 
5. Finish the call  
a. “No problem at all! This decision does not impact the care your loved one will 
receive here at the Glebe Centre. Once the project is completed, your loved one 
will still have the option of using the bike, without being part of any research 
project.” 
b. “Thank you very much for your time.” 
 
 

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Appendix I: Participant Consent Form 
 
The following document will be used solely with residents that have the ability to provide informed 
consent. This will be decided by the health care team.  
 
Participant Consent 
Form May2019_Clean 
 
 
 
 

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Appendix J: SDM Consent Form 
 
The following document will be used with substitute decision makers for residents that do not 
have the ability to provide informed consent. This individual must be identified in the resident’s 
file as a substitute decision maker.  
 
 
SDM Consent Form 
Consent Form May2 
 
 
 
 
 

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Appendix K: Master Code List 
 
*This mater code list will be password protected and only saved on the secure server at The 
Glebe Centre.  
 
Resident Name 
Participant 
Code 
Room Number 
SDM 
SDM Contact 
Number 
Jennie Smith 
PN01 
424 
Johnnie Smith 
613-555-5555 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Appendix L: CABHI Budget 
 
 
 

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Appendix M: Summary of Fall Prevention Program at The Glebe Centre 
This program focuses on reducing the incidence of residents’ falls and mitigating risks of falls 
through a resident focused, team approach which ensures that a resident’s environment and 
social, physical, cognitive and emotional strengths are supported. The program ensures team 
training, communication and effective care planning. This is an interdisciplinary program 
involving nursing and program staff, physician/pharmacist, dietician, physiotherapist, 
housekeeping staff and the resident/POA. They communicate regarding their planned 
interventions and evaluation of resident progress and outcomes in falls prevention through 
documentation. This program works in collaboration with the Centre’s Restraint reduction and 
Restorative care programs. 
 
Every Resident’s Fall Risk is assessed using Scott Fall Risk Assessment by registered nursing 
staff on admission, after a fall and when there is a significant change in condition. Based on the 
assessment residents are categorized into High and Very High risk and Interventions are targeted 
in areas contributing to falls. 
 
A number of fall prevention tools are used in the facility such as motion sensors, seat belt alarms, 
bed sensor pads. Hourly rounding of residents to prevent falls and avoid use of restraints is also 
part of the daily routine. Equipment such as fall mats, hip protectors, low electric bed are also 
used to prevent significant injury in case of a fall. 
 
The Restorative Program also works along with the Fall Prevention Program in identifying those 
at high risk for falls and exercises are carried out by nursing staff seven days a week to 
strengthen lower extremities and prevent falls. Along with Nursing, Physiotherapy staff and 
program facilitators are also involved in providing balance and strength exercises which area 
core component of the Fall Prevention Program to reduce the number of falls.  Residents’ Fall 
Risk is communicated at the Interdisciplinary Care Conferences to keep families (POA/ADM) 
informed of the actions taken to prevent falls. 
 
The Nurse Practitioner assigned to The Glebe Centre is referred to one-time fallers to rule out 
medical causes to prevent further fall.   The Co-coordinator of Nursing Program audits all falls 
on a daily basis and acts as a resource to the rest of the staff in identifying risk areas, suggesting 
new interventions and also responsible for reviewing the program on an annual basis. 
 
 

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Appendix N: Poster for presentation in main foyer 
Poster was presented at 2018 Regional Geriatric Annual General meeting and will be used to 
promote study by being placed in main foyer of The Glebe Centre to advertise the research.