Evaluation of the Home Support Exercise Program in Sudbury and Manitoulin: Final Report

Evaluation of the Home Support Exercise Program in Sudbury and Manitoulin- Final Report (PDF, 796 KB)

The Home Support Exercise Program is an important initiative to help seniors at risk of losing their independence.

The Home Support Exercise Program (HSEP) is an evidence-based physical activity intervention delivered through home support agencies. It targets hard-to-reach seniors living in the community who are at high risk for loss of functional independence.

Executive summary

In late 2009, funding for new comprehensive, community-based falls prevention initiatives was provided in Sudbury and districts through the North East Local Health Integration Network (NE LHIN) under the Aging at Home Strategy. This capacity-building project provides an opportunity to coordinate current falls prevention services being offered within the City of Greater Sudbury and the Sudbury and Manitoulin districts. As part of this initiative, eight home support service providers in the Sudbury and Manitoulin districts were funded to implement the Home Support Exercise Program (HSEP) for their clients.

The HSEP is an evidence-based physical activity intervention delivered through home support agencies. It targets hard-to-reach seniors living in the community who are at high risk for loss of functional independence. The program includes “10 simple yet progressive exercises” designed to enhance and maintain functional fitness, mobility, balance and independence for seniors.

The Sudbury & District Health Unit led the evaluation of the HSEP implementation in the Sudbury and Manitoulin districts. The evaluation of the HSEP was both a process and an outcome evaluation. The purpose of the evaluation of the HSEP was to identify the facilitators and barriers to the implementation of the program, to determine if the planned activities have had the desired impact on the target populations, to measure progress, and to inform planners about the development and implementation of future falls prevention strategy work plans.

Data for the outcome evaluation was collected in two waves. The first wave included 154 clients from the eight agencies in which the HSEP was implemented. The second wave included 93 clients from five agencies, two of which were different from the first wave. The intermediate outcome of the HSEP was evaluated by comparing data from clients both before and after the eight-week program period, using two different instruments: the Falls Efficacy Scale (FES), a measure of the client’s fear of falling during essential, non-hazardous daily activities, and the TUG Test, a measure of the client’s mobility.

Following the first wave of data collection and analysis of client outcomes, it was determined that the program evaluation would benefit from an assessment of the factors influencing those outcomes including client perceptions of the program, environment, context and program implementation. A process evaluation, which consisted of key stakeholder interviews with representatives from eight provider agencies and post-intervention follow-ups with 44 clients, was also carried out.

Results—process evaluation

Interviews with key stakeholders from the provider agencies revealed that the HSEP was delivered in one of two manners: on an individual level in the home, which is the way the program is intended to be delivered, and in a group format. Key stakeholders identified challenges with identification of suitable clients for the HSEP, and with training of personal support workers.

Based on findings from both the key stakeholder interviews and the client surveys, we can conclude that the staff who deliver the program are essential to making the HSEP work. Ongoing encouragement and support from the personal support worker or team leader is an important facilitator to continued participation in the program. In instances where clients felt there was insufficient support or follow-up, completion rates of the program were much lower. The motivation of improved mobility, balance and function is also an important facilitator, and should be used to “sell” the program to potential participants.

A number of reasons for non-completion of the program by the client were identified. Some clients were unable to do the exercises for physical reasons, including pain or injury. Other clients became ill or went to the hospital. A small number of clients were discharged from the Community Care Access Centre (CCAC) and subsequently lost to follow-up. Others were not interested in participating after the initial demonstration and therefore chose not to complete the program.

The program is very well received by agencies and most wish to continue with program delivery. The program is also well received by clients, who, for the most part, feel the program meets their needs. It is also encouraging to note that almost half of the participants continued to do the exercises even after the completion of the program. Agencies appreciate that the HSEP is an evidence-based program, that the exercises are easy to do and that there is good structure to the program.

Results—outcome evaluation

Baseline data was collected in two waves from a total sample of 247 individuals. Post-intervention data was obtained from 160 (64.8%) of the 247 clients captured at baseline. Clients came from 10 different participating agencies. A large majority (84.8%) were classified as being at risk for falling.

The results appear to demonstrate a small yet significant improvement among clients following implementation of the program. On average, clients who completed the program achieved a 2.1 second improvement in their TUG Test results, which is statistically significant. More than half of the clients who completed the program saw their TUG test results improve from baseline, most by between 1 and 10 seconds. As well, overall client confidence appeared to improve for all of the components of the Falls Efficacy Scale (FES), though this improvement was statistically significant for only 4 of the 10 components.

Improvement in mobility was more pronounced among clients with poorer baseline TUG Test scores. The level of improvement in mobility varied by participating agency, and these differences persisted after adjusting for other client characteristics. The differences may be related to how the program was delivered, or to other explanatory factors not captured in the analysis. The differences do not appear to be related to delivery of the program in a group vs. an individual setting.

Clients who were at risk for falling had larger improvements in mobility on average, though this effect appears to be explained by other factors. Linear regression analysis revealed a significant interaction between the data collection wave and baseline TUG Test score. While having a poorer baseline TUG Test increased a client’s improvement in TUG Test results on average, this effect was significantly more pronounced in the second data collection wave. This may be due to changes in the implementation of the program between the two waves. A greater effort was made in the second wave to obtain a high rate of completion of the post-intervention tests, which likely focused on higher risk/lower mobility clients (who had a higher rate of drop-out during the first wave).

The lack of a comparison group limits our ability to attribute the observed improved client outcomes to the implementation of the program. To the best of our knowledge, there were no changes in the clients’ environment that may have otherwise led to their improved results in the absence of the intervention, although data was not collected on the environment. It is reasonable to conclude that the exercise program was responsible for at least some of the observed improvement.

Conclusion and implications for practice

The findings of this evaluation demonstrate that participation in the Home Support Exercise Program (HSEP) is associated with a small yet statistically significant improvement in client confidence and mobility. The program appears to be especially effective among higher risk clients—those with lower mobility at baseline.

These findings provide support for the broader implementation of the HSEP among older adults locally, as a means to help them maintain their health and functional independence, and to lower their risk for falls and fall-related injuries.

There are a number of items that need to be considered, however, with broader implementation of the HSEP. These include appropriate processes to properly identify suitable clients for the program and provision of ongoing encouragement and support for continuation of the exercises.

These strategies could help mitigate some of the physical limitations that are a barrier to completion of the program, and could help with increasing client interest in the program. Ensuring consistency with the support worker is also important, since this person plays such a key role in clients continuing the program. It may also be valuable for the personal support worker and other support workers who are working on this program to have an opportunity to share lessons learned and approaches that have been successful with clients.

It may also be valuable to further explore the instances where the program is being offered to groups of individuals. The original intent of the HSEP is for delivery to individuals in the home. There is another program, Stand Up!, which is intended for group delivery with more mobile seniors. It would be important to determine what, if any, overlap there is with the delivery of HSEP in a group setting and Stand Up!

Overall, the results of this evaluation are supportive of the continuation of the HSEP Program in Sudbury and Manitoulin districts. The program has been well received by the community, and the agencies that work with the older adult population in the SDHU catchment area are continuing to offer this important program to their clients.

Authors

Michael King, Sudbury & District Health Unit
Renée St Onge, Sudbury & District Health Unit
Renée Chevrier-Lamoureux, Sudbury & District Health Unit
Laurel O’Gorman, Sudbury & District Health Unit
Stephanie Collins, Sudbury & District Health Unit

Acknowledgements

The authors would like to thank the following individuals for their contributions to this report:

Laurie Fraser
Jodi Maki
Jana Belanger
Natalie Aubin
Susan Snelling
Suzanne Lemieux

Contact for more information or to request a copy of the full report

Information Resource Centre
Resources, Research, Evaluation and Development Division
Sudbury & District Health Unit
1300 Paris Street
Sudbury, ON P3E 3A3
Telephone: 705.522.9200, ext. 350
Email: resourcecentre@sdhu.com

Recommended citation

Sudbury & District Health Unit. (2013). Evaluation of the Home Support Exercise Program in Sudbury and Manitoulin: Final Report. Sudbury, ON: Author.

Copyright

This resource may be reproduced, for educational purposes, on the condition that full credit is given to the Sudbury & District Health Unit. This resource may not be reproduced or used for revenue generation purposes.

This item was last modified on April 8, 2016