Winston-Salem State UniversityACL Grantee, 2019-2022

Piedmont Partners in Fall Prevention

Virtual OtagoMay 27, 2020Otago Work Group

Piedmont Partners in Fall Prevention

1. Grant Objectives1. Build capacity and sustainability for evidence-based fall prevention

programs in Piedmont area North Carolina, especially in underserved populations1. YMCA Tai Chi Moving For Better Balance2. Matter of Balance3. Otago

2. Revitalize the Piedmont Falls Coalition

Impact of Covid-19 on Grant Initiatives

• All 3 programs were offered in-person prior to Covid-19• Post-Covid-19 two programs were granted approval for virtual

formatting• YMCA Moving for Better Balance

• Taught in person by YMCA certified instructors• Otago

• Taught in person by grant team OTs/PTs and supported by all OT and PT students, all previously required to complete online Otago certification

• First Step: Get Approval!

What is Next After Getting a Green Light?!• Identify technology that is HIPPA compliant and as easy as possible for older adults to

use • Zoom for Healthcare Providers

• Develop digital consent (and get legal office approval), documentation form, and scheduling system • password protected Google docs

• Develop training material for team members and student volunteers• Loom video

• Develop Zoom tutorials for participants• Rush tutorial (https://www.ncoa.org/resources/instructions-for-accessing-your-virtual-workshop-

through-zoom/)• Develop safety video for home setup for participants • Develop virtual recruitment flyer and share with community partners• Gather links to fall prevention resources

Meeting Otago Fidelity with Virtual Format

• Obtained approval through our ACL-NCOA representative• Utilized the Otago national guidance for program design• Agreed on 8-week format with weekly 1-hour synchronous virtual

classes and weekly calls for checking on home program compliance (no less than 5 calls or no more than 8 calls, performed by Otago certified OT and PT students & documented in WebPT system) • Met with UNC Otago representatives via Zoom for consultation to

ensure fidelity based on proposed format• Gained IRB approval of amended methodology to current study

Otago Guidance for Virtual Format

• https://d2mkcg26uvg1cz.cloudfront.net/wp-content/uploads/Otago_Exercise_Program_COVID-19_Guidance_final.pdf

Planned Virtual Otago Class Format

• Max limit of 12 participants• Session zero for pre-testing and last session for post-testing• Weekly in-person sessions with 2 instructors for 8 weeks• Have one licensed instructor (OT or PT) to make initial exercise

recommendations, teach the weekly class and monitor progress of participants• Have on additional instructor to watch participants and handle

technology issues and who can teach class sessions as needed• Anticipate pairing a faculty member with one student for 2 classes

Participant Needs & Preparation

• Instructions for class preparation• Home safety• Proper attire/footwear• Ankle weights (instruction for home construction)• Scheduling weekly check-in calls, contact for issues or questions

• Device with camera/audio• Instructions on muting/video sharing, leaving the meeting• Join meeting early for social interaction• Already received a zoom tutorial for the fall risk screening

Biggest Hurdle: Virtual Fall Risk Screening

Making Fall Risk Screenings Virtual & Safe

• Considerations for the Current Screening Method• Will it work virtually? YES• Will it be safe? YES• Will it predict fall risk accurately if revised? TBD• How do we get consent? Digitally• How do we maintain confidentiality in virtual setting? Zoom• Will we be able to recruit? Partners• Will the participants be able to manage the technology? YES

Zoom Tips for Fall Risk Screenings

• Need Zoom account that allows unlimited participants (not the free trail version) and is HIPPA compliant• Need a Wizard of Oz (someone to run the technology during the

screenings)• Need a team member to field IT questions, phone calls• Stagger scheduling and use Zoom waiting room• Utilize Zoom breakout rooms (unlimited #)• Pair a licensed clinician with a student (or less experienced screener) • This pair stayed in the breakout room and screened one participant at a time• One documented while one screened

Virtual Fall Risk Screenings Components

• Subjective medical history questions• Overall health rating to assess need for Healthy Living online program

with local AAA• Physical tasks using STEADI• Fall risk algorithm to determine recommendations and referrals• Secure Google doc to record findings and identify resources needed• Follow-up email with links to resources and referral to virtual Otago

Fall Risk Screening Team

Current Progress & News

• Virtual class scheduled to start June 4• Held one fall risk screening session• Screened 15 older adults in 8 breakout rooms• Had 30 scheduled• 6 appropriate for virtual Otago, 1 signed up for virtual Otago already!

• Two more screening sessions planned• Mornings 11-12 seem to work well for older adults• About 40 scheduled for these two sessions• Hope to have enough for 2 Otago classes

Future Plans

• Pilot of virtual YMCA Moving for Better Balance with Northwest NC YMCA• Continue virtual fall risk assessments to reach isolated older adults in

the community• May add questions on social isolation/depression• Copyright the algorithm, disseminate results• Replace some in-person screenings with virtual?

Questions

• Feel free to contact:• Sara Migliarese, PT, PhD, NCS, MSCS: migliaresesj@wssu.edu• Megan Edwards Collins, PhD, OTR/L, CAPS: edwardsme@wssu.edu• Grant team: aclfallsgrant@wssu.edu