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Stepping Out of the Box

Western Sydney Local Health District
Project Added:
14 July 2015
Last updated:
4 September 2015

Stepping Out of the Box

Summary 

A group rehabilitation class was established for eligible clients in weeks 6-12 of the Transitional Aged Care Program (TACP), incorporating education, physical activity and social activities. 

Aim

To ensure at least 85% of eligible clients attend group rehabilitation in weeks 6-12 of the Blacktown TACP by April 2015.

Benefits

  • Increases physical activity, which has potential benefits including reduced risk of muscle loss, memory loss, mental illness, cardiovascular problems, high blood pressure, some cancers, osteoporosis and rheumatoid arthritis.
  • Decreases social isolation and improves relationships with other clients in a similar situation.
  • Educates clients on topics specific to the aged population and increases mental stimulation.
  • Encourages clients to engage in social or group therapy after the TACP has finished.
  • Provides clients with a sense of mastery and accomplishment.
  • Improves staff job satisfaction.

Project status

Project dates

  • Planning phase: August 2014
  • Project start: November 2014
  • Project finish: April 2015.

Project status

Sustained - the project has been implemented, and is being sustained in standard business.

Background 

The Blacktown TACP is a 12-week rehabilitation program for clients aged 70 and over who are living in Blacktown. All intervention and therapy is provided in the client’s home, by a multidisciplinary team of occupational therapists, physiotherapists, social workers and community care aides.

As a high proportion of clients in the TACP live alone and don’t have regular contact with others, many reported feeling socially isolated. Other feedback from previous TACP participants included:

  • the desire for social activity to be incorporated into the program
  • the importance of improved physical function to regaining and maintaining independence
  • concerns about being re-admitted to hospital or being admitted to an aged care facility
  • concerns about losing their memory and getting dementia
  • feeling low in mood and helpless about their situation
  • lacking the motivation to initiate physical activity on their own
  • the desire to avoid other social groups, exercise groups or allied health intervention after the program, as they are used to receiving therapy in their own home.

It was decided that a group rehabilitation class for TACP participants would overcome many of these challenges and improve the health and wellbeing of clients during and after the 12-week program.

Implementation 

  • A project team was established with all team members in the TACP.
  • Using clinical methodology, the project team conducted client interviews to determine potential barriers for attending a weekly group rehabilitation class.
  • Eligibility criteria for clients was established and clients were made aware of the group rehabilitation when they joined the program.
  • The outpatient gymnasium at Mt Druitt Hospital was chosen as the location for the class.
  • Weekly classes were held on Thursdays from 10am to 12pm.
  • Transportation of clients to and from the class was provided by TACP community care aides.
  • Each session included an education, exercise and social component (games and morning tea).
  • An occupational therapist, physiotherapist and community care aide was present each week to run the class.
  • Education topics changed each week and were relevant to the aged care population.
  • Physical exercises were tailored to each client, depending on their functional ability and diagnosis.
  • Different games were played each week to engage clients and provide variety.
  • Clinical documentation was completed for each client who participated in group rehabilitation.
  • Resources including games, activities, exercise equipment and morning tea were sourced.

Blacktown TACP patient brochure

Implementation site

Mt Druitt Local District Hospital (Outpatient Gymnasium), Western Sydney Local Health District

Partnership

Clinical Leadership Program 

Results

  • The projected aim of at least 85% of eligible clients attending group rehabilitation has been achieved.
  • Eligibility of clients varies week to week, depending on the number of TACP clients at that time.
  • Attendance of clients is recorded every week, with an average of six to eight per session. Reasons for non-attendance are also recorded. Non-attendance is often due to illness or medical appointments. A client satisfaction survey was completed at the end of the project (week 12), with a staff satisfaction survey completed at the conclusion of the TACP (six months). Feedback received was mostly positive, including:
    • the opportunity to meet new people in a similar situation
    • participation in group exercises which increased motivation
    • a stronger desire to participate in other groups following the completion of TACP
    • improved job satisfaction in staff, by seeing improvements in client outcomes
    • an improvement in clients’ knowledge of various topics, including medication management, falls prevention, healthy eating and signs of a stroke.
  • A number of measures were used to determine the success of the project, including:
    • Quality of Life Satisfaction Survey
    • Timed Up and Go
    • 3-Minute Walk Test
    • Problem-Oriented Assessment of Mobility (POAM).
  • The biggest improvements in physical health were found in the 3-Minute Walk Test and Timed Up and Go.
Outcome Measure
Average at week 12 

Non group
Group
Timed Up and Go
32.5 seconds
15.9 seconds
3 Minute Walk Test
88.4 metres
131.6 metres
POAM
20.3/28
24.7/28
Quality of Life
7.5/10
7.7/10

Chart showing percentage of eligible clients attending group varying between 100% and 44%

Lessons learnt

  • Non-attendance was often for reasons beyond the project team’s control, such as illness or medical appointments.
  • It was found that some measures used to evaluate the program were not a true indicator of the project’s success and as such a review must be undertaken. For example, participants were chosen as they were more physically capable and so more likely to score better in the evaluation measures already, than those who do not attend the program.
  • Not all games chosen for the social component were suitable for clients of varying education and cultural backgrounds.
  • Staff spent a significant amount of time providing transport for clients to attend group rehabilitation. Only one car was available to transport three clients at a time, with minimal room for mobility aids. This issue needs to be addressed moving forward, to ensure staff are as efficient as possible.
  • It was found that the size of the outpatient gymnasium was too small for the number of participants in the group, which continues to increase.
  • It was important to engage all team members in the planning and implementation phase of the project.
  • Client feedback and input into the design of the group rehabilitation program was essential to its success.
  • It was necessary to access clinical tools and clinical leadership skills for the planning and implementation stage of this project.

Further reading

  • Barnett A, Marion ET, Smith B et al. Community-based group exercise improves balance and reduces falls in at risk older people: a randomised controlled trial. Journal of Age and Ageing 2003; 32(4): 407-14.
  • Laurin D, Verreault R, Lindsay J et al. Physical activity and the risk of cognitive impairment and dementia in elderly persons. Archives of Neurology 2001; 58(3): 498-504.
  • de Jong Gierveld J, van Tolburg T, Dykstra PA. Cambridge handbook of personal relationships. Cambridge: Cambridge University Press; 2006: 485-500.
  • White B. Measuring Patient Satisfaction: How to do it and why to bother. Journal of Family Practice Management 1999; 6(1): 40-4.

Contact

Amanda Hodges
Senior Occupational Therapist, Blacktown TACP
Western Sydney Local Health District
Phone: 02 9881 7187 or 0419 803 722
Amanda.Hodges@health.nsw.gov.au

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