The Telephysiotherapy for Older People (TOP-UP) program for improving mobility in people receiving aged care: a hybrid type 1 effectiveness–implementation randomised controlled trial

Objectives: To assess the effectiveness and implementation of a telephysiotherapy program for improving mobility, mobility goal attainment, and quality of life of people receiving at-home or residential aged care. Study design: Hybrid type 1 effectiveness–implementation randomised controlled trial. Setting, participants: People aged 65 years or older who were receiving community or residential aged care services in Australia, 1 September 2021 – 30 November 2023. Intervention: Telephysiotherapy for Older People (TOP-UP): six-month program of ten telephysiotherapy (Zoom) sessions for assessment and tailored exercise prescription, supported by trained aged care workers and exercise videos. Main outcome measures: Primary outcome: mobility (Short Physical Performance Battery [SPPB] score at baseline and six months). Secondary outcomes: fall rate (per person), proportion of people with falls, SPPB components (sit-to-stand performance, balance, gait speed), pain (visual analogue scale), mobility goal attainment, physical activity (Incidental and Planned Exercise Questionnaire), quality of life (EQ-5D-5L visual analogue scale). Results: A total of 1348 people were screened at 27 sites, and 242 eligible people were recruited for the trial (mean age, 83 years [standard deviation, 8 years]; 158 women [65%]); 92 of 120 intervention group participants and 100 of 122 control group participants completed the six-month. After adjusting for baseline mobility scores, the mean difference in mobility score at six months (intervention v control group) was 2.1 (95% confidence interval [CI], 1.4–2.7) points. Sit-to-stand performance was more likely to improve in intervention than control participants (adjusted odds ratio, 2.7; 95% CI, 1.3–4.3); intervention participants reported greater quality of life (EQ-5D-5L visual analogue scale: adjusted mean difference, 6.2 [95% CI, 1.8–10.7] points) and less pain (visual analogue scale: adjusted mean difference, –1.1 [95% CI, –1.8 to –0.3] points), and a smaller proportion experienced falls ...