GGM

Journal of Gerontology

and Geriatric MedicineISSNISSN 2697-4509 (Online)

GGM

Journal of Gerontology

and Geriatric MedicineISSN 2697-4509 (Online)

Article

ปีที่ 24 ฉบับที่ 2 กรกฎาคม-ธันวาคม 2025 (46-58)

Development of Otago Exercise Programme Delivered via Tele-Physical Therapy of Fall Prevention in Rural Thai Older Adults

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Thasinee Suvittanatiti1, Pornpimol Suksanphaisan2, Pakaratee Chaiyawat3

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1Department of Physical Therapy, Ban Pong Hospital, Ratchaburi Province, Thailand.
2Department of Physical Medicine and Rehabilitation, Ban Pong Hospital, Ratchaburi Province, Thailand.
3Faculty of Physical Therapy, Mahidol University

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Abstract

Background and aims: Thailand has rapidly transitioned to a complete aged society, with falls constituting a major, preventable cause of injury and functional decline among older adults. Scalable, home-feasible programmes that target balance and strength, such as the Otago Exercise Programme (OEP), may mitigate fall risk. Tele-physical therapy could enhance access in rural settings. This study evaluated the feasibility and effectiveness of a 12-week, home-based modified OEP delivered via tele-physical therapy for community-dwelling older adults at intermediate risk of falls in rural Thailand. Methods: A mixed-methods study comprising a randomized controlled trial (RCT) with qualitative in-depth interviews was conducted at Ban Pong Hospital and 24 affiliated primary care units, Ratchaburi Province, Thailand. Community-dwelling adults with intermediate fall risk, without high-risk features, were eligible. Of 65 screened, 50 were randomised to intervention (n=25) or control (n=25). The intervention was a modified OEP (17 balance and strength exercises plus walking) delivered via tele-physical therapy (video calls, pre-recorded videos, and manuals), three 30–40 min sessions/week for 12 weeks. Controls received usual care. Primary outcomes were Short Physical Performance Battery (SPPB) and Activities of Daily Living (ADL). Results: At baseline, there were no statistically significant differences between the intervention and control groups in demographic or clinical characteristics (p > 0.05). After 12 weeks, the intervention group demonstrated significant improvements (p < 0.05, Cohen’s d = 0.7 for gait speed) compared with controls across all domains of the Short Physical Performance Battery, including balance, gait speed (0.72 ± 0.11 to 0.89 ± 0.14 m/s), and chair stand test (12.8 ± 2.1 to 10.3 ± 1.9 s) (p < 0.05). No significant changes were observed in the control group. Activities of Daily Living independence was maintained in both groups. Exercise adherence in the intervention group was 100%. Conclusions: The 12-week, tele-delivered modified Otago Exercise Programme effectively improved physical performance among rural Thai older adults at intermediate fall risk, with excellent adherence and no reported adverse events. These findings support the potential of tele-physical therapy as an accessible strategy for fall prevention in community settings. Larger, longer-term trials are warranted to evaluate fall incidence, durability of benefits, and cost-effectiveness.

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Keyword

Falls; Otago Exercise Programme; Tele-physical therapy; Older adults; Thailand

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References

  1. United Nations Economic and Social Commission for Asia and the Pacific (UN ESCAP). Asia-Pacific
  2. Regional Conference on Population Ageing: Reframing Ageing in the Context of Socio-Economic
  3. Transformation. Bangkok: UN ESCAP; 2024.
  4. National Statistical Office of Thailand (NSO). Population Projection for Thailand 2020–2040. Bangkok:
  5. NSO; 2024.
  6. World Health Organization. WHO global report on falls prevention in older age. Geneva: The Organization; 2007.
  7. Lord SR, Sherrington C, Menz HB, Close JCT. Falls in older people: risk factors and strategies for prevention. Cambridge: Cambridge University Press; 2007.
  8. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75(1):51–61.
  9. Thai Health Promotion Foundation. Elderly Fall Prevention Program. Bangkok: THPF; 2021.
  10. Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc. 2005;53(9):1618–1622.
  11. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35 Suppl 2:ii37–41.
  12. Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma. 2001;50(1):116–119.
  13. Panel on Prevention of Falls in Older Persons, American Geriatrics Society, British Geriatrics Society. Summary of the updated AGS/BGS clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–157.
  14. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;(9):CD007146. doi:10.1002/14651858.CD007146.pub3
  15. Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2018;(7):CD012221. doi:10.1002/14651858.CD012221.pub2
  16. Ubon Ratchathani Provincial Health Office. Community elderly health report. Ubon Ratchathani: Provincial Health Office; 2020.
  17. National Statistical Office of Thailand. Survey on elderly health in Ratchaburi Province 2024. Bangkok: National Statistical Office of Thailand; 2024.
  18. Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011;22(3–4):78–83.
  19. Campbell AJ, Robertson MC. Otago Exercise Programme to Prevent Falls in Older Adults. Otago: University of Otago; 2003.
  20. Sherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2023;(10):CD012221.
  21. Kocic M, Stanojkovic I, Milenkovic T, Nikolic D, Lazovic M, Miler-Jerkovic V, et al. The effectiveness of group-based Otago exercise programme on physical performance in nursing home residents. Clin Interv Aging. 2018;13:503–509.
  22. Leung KK, Lee DTF, Chan CKY, Chong MY, Lam LCW. Tele-rehabilitation for fall prevention in community-dwelling older adults: a systematic review. BMC Geriatr. 2023;23:149.
  23. Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults? A systematic review and meta-analysis. Age Ageing. 2010;39(6):681–687.
  24. Foundation of Thai Gerontology Research and Development Institute (TGRI). Situation of the Thai Older Adults 2024. Bangkok: TGRI; 2024.
  25. World Health Organization. World Report on Ageing and Health. Geneva: WHO; 2023.
  26. Bernocchi P, Vitacca M, La Rovere MT, Volterrani M, Galli T, Baratti D, et al. Home-based telerehabilitation in older patients with chronic diseases: a randomised controlled trial. J Telemed Telecare. 2017;23(9):725–733.
  27. Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31(5):625–638.
  28. Leung KK, Lee DTF, Chan CKY, Chong MY, Lam LCW. Tele-rehabilitation for fall prevention in community-dwelling older adults: a systematic review. BMC Geriatr. 2023;23:149.
  29. Valenzuela T, Okubo Y, Woodbury A, Lord SR, Delbaere K. Adherence to technology-based exercise programs in older adults: a systematic review. J Geriatr Phys Ther. 2018;41(1):49–61.
  30. Ministry of Public Health, Thailand. National Strategic Plan for Digital Health (2023–2032). Nonthaburi: MOPH; 2023.
  31. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. Br Med J. 1997;315(7115):1065-9.
  32. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing. 1999;28(6):513-8.
  33. Skelton DA, Dinan SM, Campbell MG, Rutherford OM. FaME (Falls Management Exercise): An RCT on the effects of a 9-month group exercise programme in frequently falling community-dwelling women age 65 and over. J Aging Phys Act. 2004;12(3):457-8.
  34. Skelton DA, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise – FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing. 2005;34(6):636-9.
  35. Galet C, et al. Stepping On fall prevention program reduces falls in older adults. J Gerontol Nurs. 2023;49(8):43-50.
  36. Yang Y, Wang K, Liu H, et al. The impact of Otago exercise programme on the prevention of falls in older adults: a systematic review. Front Public Health. 2022;10:953593.
  37. Li F, Harmer P, Fitzgerald K, et al. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(10):1301-1310. doi:10.1001/jamainternmed.2018.3915.
  38. Huang ZG, Feng YH, Li YH, Lv CS. Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open. 2017;7(2):e013661.
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