The Functional Fitness MOT for Community-Dwelling Older Adults in Thailand
Authors:   , Rakkamon Warin 
Published: May 2024

Thailand's population is ageing and by 2050, older adults are predicted to account for more than 35% of the overall population. Therefore, there is a need for public health interventions to help older Thai adults maintain physical function and improve physical activity levels. In the UK, the FFMOT is a public health intervention that provides tailored advice on increasing fitness following functional tests compared to normative data. This PhD thesis aimed to investigate the feasibility and acceptability of a culturally adapted FFMOT programme, delivered in Thailand. The body of work contained in the thesis has: i) adapted the FFMOT to the Thai context, ii) established whether suitable normative data already exists, and, as there wasn’t, (iii) collected normative data from older Thai community-dwelling adults, (iv) conducted a feasibility study of the FFMOT. Based on the first phase of MRC framework for complex interventions, the UK FFMOT was adapted for delivery in a new context (Thailand). The adaptation was designed collaboratively with the original FFMOT intervention developer and included: i) adding multiple follow-up visits (face-to-face motivational sessions for 40 minutes in weeks 2, 6, and 10), ii) translating all resources from English to Thai, iii) online training (e-learning) to create standard operating procedures for all community physiotherapists. The FFMOT uses normative data to compare the FFMOT test results (for 30-sec chair stand, chair sit and reach, back scratch, 8-foot up and go, 6 min walk, single-leg stance and handgrip strength tests) with gender and age-referenced norms. It is important to use current and relevant normative data so that comparisons made are suitable for the population comparison. Therefore, a systematic review was conducted to determine whether suitable normative data exists for use in Thailand and, if not, see if it was best to use worldwide aggregated data, regional data or whether collection of new normative data was necessary. The systematic review gathered normative data for the seven tests used in the FFMOT from 42 studies from 30 countries, totaling 74,349 men and women. There were wide heterogeneity in test results from across the world, so normative data for the seven tests is presented for seven geographic regions. Gender differences were more pronounced in some countries than others, and the differences in test results between regions was more noticeable in some tests than others. However, there was no relevant data for Thailand across any of the FFMOT tests and so the collection of normative data for Thailand was necessary. The normative data study used a cross-sectional study design across eleven rural/urban areas in Thailand. Six hundred and forty-one (641) older community-dwelling adults aged 60-89 years were recruited between January and October 2022, by 11 physiotherapists trained in the FFMOT test procedures. A reliability study was completed in a subsample and showed high ICC accuracy. Normative data are presented within each gender and 5-year age band (60-89), mean, standard deviation, percentiles and 95% confidence intervals. This study provides current and comprehensive normative data for seven functional tests for Thai men and women aged 60-89 which can be used in the feasibility study of the FFMOT in Thailand. In the second phase of MRC framework, the feasibility of running the FFMOT with older Thai community-dwelling adults was investigated. The Thai FFMOT was delivered by four trained community physiotherapists in four distinct settings that represented all regions in Thailand and covered a mix of urban and rural areas. Thirteen per cent (n=21) of older adult participants screened met the eligibility (medically stable and inactive) and 100% accepted the invitation to join the FFMOT. Twenty-one older Thai community-dwelling adults undertook the FFMOT, and 100% completed the full 12-week period of the FFMOT, with no data loss. In focus groups and interviews, both older adults and the physiotherapists expressed that the FFMOT was ‘all good’ and appeared to be practical, acceptable and feasible. They recommended it be provided across Thailand to support health promotion and gave advice on small improvements that could be made. Although not powered to show change in the functional tests or physical activity and sedentary time, there were improvements in physical activity and potentially clinically significant improvements in physical function. In conclusion, the Thai FFMOT was feasible and acceptable in Thailand and needs to be taken to a large definitive RCT study of effectiveness.