Exercise is known to prevent falls, so members of the Australian and New Zealand Falls Prevention Society (ANZFPS) are conducting trials to help Australians with mobility issues incorporate physical exercise into their daily routine.
According to Professor Cathie Sherrington, the Deputy Director for the Institute for Musculoskeletal Health, there is an urgent need for scalable interventions which directly assist patients to incorporate exercise into their lives.
Prof Sherrington and her team are conducting the ComeBACK study, which aims to help people with disabilities- particularly mobility problems- become more active, safely. Speaking about the trial, Prof Sherrington talked about the ways the trial was optimised to work with patients remotely.
“A lot of research has been done that supports one-on-one physiotherapy-led interventions. We know they can have lots of benefits improving function and preventing falls, but even in the best circumstances, we can’t necessarily offer that one-on-one treatment to everybody. We were already looking at ways to deliver that more efficiently and increasing access to more people by using existing technologies.”
The novelty of ComeBACK comes from the emphasis on scalable interventions. Previous trials have involved more supervised exercise programs. While those trials are beneficial, ComeBACK aims to deliver those services in a more pragmatic way with telephone coaching, text messages and activity monitors. The trial is focussing on supporting behaviour change among participants.
When asked about the challenges of introducing remote trials to an older demographic, Prof Sherrington said the technology has been very well received.
“We’ve found that with the right amount of support and adequate training, older people are very technologically literate. There have really been no issues with remote access, and I think in a lot of ways it’s actually preferable because this is another way that ComeBACK can fit into our participants’ existing routines,” she said.
Consumer involvement
The ComeBACK team involved consumers in the design of the intervention—basing it on previous trials that had involved qualitative research, as well as informal consultation with consumer advocates.
The trial design is consumer-focussed; by using physiotherapy experts to tailor interventions for participants, ComeBACK acknowledges participants’ external commitments and existing health conditions, while still collecting measurable data.
Conducting a clinical trial in the times of COVID-19
Operating a clinical trial during COVID-19 restrictions is a significant feat, which ComeBACK has managed successfully. Prof Sherrington feels that now, perhaps even more than pre-COVID-19, there is a greater need for clinical trials which help mobility-restricted people incorporate movement into their lives.
The primary measure of ComeBACK is steps per day, an outcome that is easily tracked and implemented into existing routines. Prior to COVID-19 restrictions, ComeBACK had already focused on telephone coaching and a single home visit from a physio, but due to COVID-19, that visit was removed, because the patients are in a high-risk age group. “We worked with our clinical intervention deliverers to work out ways of removing that face-to-face contact and doing that initial consultation virtually by working with existing technology.”
“Participants have been extremely receptive to those interventions at this time, and they’re grateful for the advice on how to maintain activity levels during COVID-19 restrictions,” said Prof Sherrington.
“With our outcome being measured in steps per day, we feel very fortunate as well because people can still be getting steps, so we’ve been able to keep the individual intervention, but tweak how people are achieving that.”