title: The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults.
abstract: BACKGROUND
  It is estimated one in two adults age 80 and over fall each year, resulting in substantial morbidity and mortality rates among this oldest-old population. The Otago Exercise program (OEP) is an evidence-based fall prevention program shown to reduce falls by 35% among high-risk older adults. The OEP was designed to be delivered in the home by physical therapists. This model has encountered multiple implementation challenges in the United States health-care system, which has resulted in the development and testing of innovative models to support a broader reach and dissemination of this program.
  
  
  METHODS
  The Northwest Senior and Disability Services is an Area Agency on Aging (AAA) serving a five-county region in Oregon. This AAA developed a model where a Certified Occupational Therapy Assistant (COTA) and exercise physiologist delivered the OEP with a physical therapist available to consult on all cases. Physical function assessments and self-reported perceptions about physical function were collected at baseline and 6 months.
  
  
  RESULTS
  Baseline measures were collected on 239 participants enrolled in the OEP, and 62 participants at 6 months. Those who completed 6 months of the OEP demonstrated significant improvements in all physical function assessments and self-perceived functional improvements. A subset of this group that demonstrated improvements in the ability to rise from a chair also reported significantly fewer falls during the 6-month intervention.
  
  
  CONCLUSIONS
  Innovative models in which the OEP exercise sessions are delivered by non-physical therapists appear to be effective in improving physical performance measures and decreasing fall risk over a 6-month period. Because these models do not require a physical therapist, they may require fewer resources to implement. These findings have implications to inform implementation and dissemination strategies to bring the OEP to scale.
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA; School of Physical Therapy, South College, Knoxville, TN, USA.
authors.forename: Tiffany E
authors.initials: TE
authors.lastname: Shubert
authors.affiliation: Health Services Administration Program, University of Phoenix-Oregon Campus , Salem, OR , USA.
authors.forename: Lavinia Spring
authors.initials: LS
authors.lastname: Goto
authors.affiliation: Department of Health Promotion and Behavior, Institute of Gerontology, The University of Georgia College of Public Health, Athens, GA, USA; Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA.
authors.forename: Matthew Lee
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Epidemiology, School of Medicine, University of California Irvine , Irvine, CA , USA.
authors.forename: Luohua
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Northwest Senior and Disability Services , Salem, OR , USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Rudman
authors.affiliation: Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health , College Station, TX , USA.
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
keywords: Otago Exercise Program; aging; evidence-based; fall prevention; frail; health promotion; innovation