Does a 10-week course of Otago exercises delivered in an NHS outpatient setting improve frailty, sarcopenia, and balance?

Purpose

The Comprehensive assessment service for older people (CASOP) are a falls and frailty prevention multidisciplinary team within University Hospitals of Derby and Burton NHS FT. They deliver a comprehensive geriatric assessment to patients who have fallen or are at risk of falling, with or without frailty. Often patients go on to receive exercise rehabilitation through one to one, home exercise programs and group delivery. Otago exercises are a well-researched intervention to improve strength and balance in an elderly population; with clinically significant improvements with 12-months of intervention delivery. A 12-month intervention is not routinely provided in the NHS. Can a 10-week course still be beneficial within an NHS setting?

mean improvement was 3.7
on TUG
mean improvement was 3.4
on BERG score

Approach

A sample of 38 patients in 2019 was selected by a physiotherapist following a comprehensive geriatric assessment to attend the Otago groups. Patients had a Montreal Cognitive Assessment (MOCA) ≥ 24/30 and a Berg balance scale (BERG) ≥ 44/56. Patients attended for a 90-minute Otago class once a week for ten weeks, delivered by trained technical instructors. Timed up and go (TUG) and BERG are used as outcome markers for frailty, sarcopenia, and balance.

Outcomes

Results: Patients improved in both their TUG and BERG scores following the 10-week intervention. The mean starting TUG score was 17.9 (95% CI 15.6 – 20.2) seconds; mean improvement was 3.7 (95% CI 1.7 – 5.8) seconds. The mean starting BERG score was 48.0 (95% CI 46.7 – 49.3); mean improvement was 3.4 (95% CI 2.1 – 4.7) points. Patients who completed the course attended for seven or more sessions with 26 (68%) attending for the full course. Overall, there were 12 (31%) dropouts; six (16%) due to medical reasons; two (5%) did not attend for final assessment; three (8%) did not start the group; 1 (3%) was transferred to one to one exercise.

Conclusion(s): A short Otago course of 10-weeks does have benefits on patients’ level of frailty, sarcopenia, and balance. Patients having completed group exercise within an NHS setting need to continue exercise at home and group exercise within a community setting, and research into how many do this and any required support is needed.

Cost and savings

Not applicable. 

Implications

Falls represent a significant health issue for those affected, with poor short- and long-term outcomes. From a societal burden, up to one in three people aged 65 years and older will fall each year, costing the NHS £4.6 million a day. Falls prevention is likely to become an increasing focus for our ageing population. Ensuring that patients at risk receive best practice assessment and intervention will help in reducing the health and social burden of injurious falls.

Top three learning points

No further information. 

Funding acknowledgements

This work received no funding.