Title: Can smartphone and teleconferencing technology be used to deliver an effective home exercise intervention to prevent falls amongst community dwelling older people? A feasibility RCT.
Funder: Department of Health and Social Care

Abstract: Aim: To explore whether the use of smartphone/teleconferencing technology can assist in delivering effective home-based exercise programmes to prevent falls.CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) One in three older people over the age of 65 fall each year (DH, 2009). Falls lead to injury and death, with implications for independence, quality of life and cost to health services. Strength and balance exercise programmes are effective in reducing risk of falls (Gillespie et al, 2012). Home-based exercise is the only option for some older adults but adherence is poor (Nyman and Victor, 2011). Attitudes relate to older adults' uptake and adherence to exercise, emphasis on personal outcomes can support older adults to have more positive attitudes about exercise (Hawley-Hague et al, 2013). However, it has also been established that across the health service 73% of home-based exercise programmes lasted for 3-months or less (RCP, 2011). This does not provide sufficient exercise dose to reduce falls risk (Gillespie et al, 2011). Cost and appropriate staffing were cited as primary reasons for this (RCP, 2011). CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Using technology to deliver virtual' one-to-one and group exercise in people's own homes could increase motivation and be a cost-effective solution to the delivery of programmes (more regular delivery due to decreased travel time) and maintenance of exercise, leading to reduced falls risk. Clinical outcomes have been found to be as good in telerehabilitation programmes as standard programmes, with good adherence levels (Kairy et al, 2009). Social networks are identified as an important element of programmes (Lai et al, 2004). CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Question: Is it feasible to deliver virtual home exercise as an alternative to standard service?CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Methods: CHAR(13) + CHAR(10) The technology:CHAR(13) + CHAR(10) This project utilises technology developed as part of the European Commission FP-7 funded FARSEEING project. FARSEEING has developed applications for the smartphone that includes a real-time fall detection algorithm/alarm system and assessment of function.This currently links to a smarthome system which promotes physical activity. The smartphone has been tested with older adults as a falls alert system, with positive results. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) This study will focus on further development of the smartphone system and test a new intervention.Two new applications will be developed that provide motivational messages (based on existing work using psychological theory) and allow participants to record home exercise. These will be used alongside a teleconferencing application to deliver evidence-based strength and balance programmes in older peoples' homes. The smartphone will plug into the television to enable a health professional to deliver virtual one-to-one and group exercise. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Usability testingCHAR(13) + CHAR(10) The falls service will identify patients whom normally require home exercise. Initially we will test acceptability/usability of the technology with patients/health professionals. Twenty patients will carry out virtual one-to-one and group exercise through the smartphone system for 2-weeks. Interviews with patients and focus groups with 15 health professionals will provide feedback. Following this, any required changes will be made to the applications. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Feasibility Randomised Controlled Trial (RCT). CHAR(13) + CHAR(10) 12-week intervention offered to 102 patients, randomised to either 1) normal service, 2) one-to-one exercise using smartphone or 3) group exercise using smartphone. This will assess feasibility of the interventions as full alternative to standard service. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Outcome measures collected by smartphone include function, real-time falls, attendance at sessions, exercise dose and adherence. Balance will be assessed. Feasibility and acceptability of design/procedures (recruitment, randomisation, follow-up assessments, retention, outcomes) will be assessed. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Impact: CHAR(13) + CHAR(10) 1. Increased exercise progression/dose which could be cost neutral/saving.CHAR(13) + CHAR(10) 2. Increased support/motivation which should lead to increased adherence.CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) This would be particularly beneficial to housebound older adults, helping maintenance of health, reducing long-term falls risk and re-access to services. This study will lead to a definitive RCT comparing effectiveness of the interventions to current provision.

Lay abstract: Aim: To explore whether the use of smartphone and teleconferencing technology can assist in delivering effective one-to-one and group home exercise to prevent falls.CHAR(13) + CHAR(10)CHAR(13) + CHAR(10) Background: Falls can lead to injury, loss of independence and death for older adults.One in three older people over the age of 65 fall each year. Falls place a heavy burden on the health service, through admission to hospital and treatment. Targeted home-exercise, including exercises to strengthen muscles and improve balance, is proven to prevent falls. However, older adults do not always maintain their exercises nor do them regularly enough to gain the benefits. Many healthcare services do not offer adequate support to enable older adults to carry out the exercises regularly enough, or for a long enough period of time. Older adults' attitudes relate to their uptake and adherence to exercise, an emphasis on personal outcomes can support older adults to have more positive attitudes and increased exercise behaviour. One-to-one and group exercise delivered by health professionals through teleconferencing using everyday technology (smartphone and television) in people's own homes could be a solution. Outcomes have been shown to be good for rehabilitation through teleconferencing, with good adherence levels and additional social benefits.The intervention would target housebound older adults providing:CHAR(13) + CHAR(10) 1. More regular exercise opportunities and additional health professional support at a low cost. CHAR(13) + CHAR(10) 2. Promotion of adherence through virtual' group support and motivational messages (promoting positive attitudes).CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) Methods: CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) The technology:CHAR(13) + CHAR(10) Recently an EC funded project (FARSEEING) developed a smartphone system that assesses function and acts as a falls detector and alarm system when worn. This links to a smarthome system which promotes physical activity. The smartphone has already been tested with older adults to detect falls/as an alert system. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) This study will focus on the smartphone system with the development of additional applications and the use of teleconferencing. The smartphone will be worn by the user and will be used to detect falls, as an alert system, to assess function, record home exercise and to provide feedback to users to help them with their motivation to exercise. In this study two new applications will be developed, providing motivational messages and recording exercise. The smartphone will also be connected to a television by the user to enable them to participate in a virtual one-to-one or group exercise in their own home with a health professional. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) The intervention:CHAR(13) + CHAR(10)Older adults will be identified by Central Manchester Falls Service as patients who would normally require home exercise. Initially we will test whether patients and health professionals like and can use the technology. We will ask 20 patients to carry out the exercises one-to-one and in a virtual' group through the smartphone technology for 2-weeks. We will then hold interviews with patients and focus groups with 15 health professionals to gain feedback. Changes will be made to the applications based on this feedback.CHAR(13) + CHAR(10) CHAR(13) + CHAR(10) This will be followed by a 12-week intervention with 102 patients, where we offer either 1) normal home exercise service, 2) one-to-one exercise using smartphone or 3) group exercise using smartphone. We will use the smartphone to establish whether we can collect information on falls as they happen, function, whether older adults attend the class, carry out the required amount of exercise, and are still attending the class at the end of the programme (adherence). Patients balance will also be assessed. We will test the study procedures (e.g. recruitment and retention) for a larger trial. CHAR(13) + CHAR(10)CHAR(13) + CHAR(10) Patient and public involvement: Older adults and health and social care professionals have been involved in the development of the proposal and will form part of a steering group managing the project, alongside a representative of AgeUK. A patient will also assist in providing support for the use of the technology during the trial. CHAR(13) + CHAR(10) CHAR(13) + CHAR(10)CHAR(13) + CHAR(10)Dissemination: A workshop at the end of the project where patients, health professionals and commissioners can hear about the intervention and try out the technology will assist us in dissemination locally. The study will lead to the development of a large trial which will compare the effectiveness of the intervention in comparison to existing services. If this intervention proves successful then local services should consider adopting it as part of service provision for falls prevention. Patient-centred resources on the use of the technologies will be developed and promoted on national/international websites. At least three papers will be published in high impact journals and findings will be presented at national/international conferences.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;6.3 MEDICAL DEVICES
Health categories: INJURIES AND ACCIDENTS