Abstract
Background:Population growth is an ongoing healthcare challenge, particularly in the management of falls in the older adult (65 years+) population. Strength and balance exercises are a cornerstone of recommended falls management programmes. Student-led exercise classes offer a unique opportunity to meet demand, while exploring the concurrent educational experience for health profession students. This study aimed to evaluate the feasibility of a student led exercise class on falls risk reduction for community dwelling older adults, and to explore this educational experience for physiotherapy students.
Methods:
A pragmatic mixed methods design was used in this thesis. A scoping review was undertaken to review the type of evidence for student led exercise interventions for community dwelling older adults at risk of falls. Three studies followed this review.
Adaptation: Adaptations for designing and delivering a student-led falls class for NHS-referred patients in a Scottish university were developed using Nominal Group Technique with key stakeholders: older adults (n=6), students (n=5), clinicians (n=14), and academics (n=8).
Feasibility: A 12-week student-led Otago Exercise Programme (OEP) was delivered to community-dwelling older adults at risk of falls (n=7, mean age=75.16) from a local NHS service, alongside an exploration of the educational experience of physiotherapy student leaders (n=6, mean age=23.67). Data included quantitative measures (e.g. Timed Up and Go, EQ-5D, Tinetti) and qualitative semi-structured interviews (thematic analysis).
Consensus: international expert consensus (n=13, mean age = 47.58 years), using a Delphi method, was undertaken using current international outcomes within physiotherapy clinical education curricula to consider the expected learning outcomes for physiotherapy students leading OEP exercise classes.
Results:
A paucity of evidence was found in the scoping review with few studies exploring student-led falls programmes for this population of patients, and none of these studies directly explored the student experience as a part of their study.
Adaptation: 11 potential recommendations were collated and refined for use within the design and delivery of the feasibility study. Recommendations covered, for example: referral procedures, travel considerations and discharge planning.
Feasibility: The Covid-19 pandemic led to a cessation of the trial. Ten weeks of the planned 12 weeks of the programme were delivered at a minimum to participants. The rigour of results was challenged due mostly to the trial cessation and related data loss. One outcome showed a statistically significant result for Quality of Life for older adult participants (EQ-5D p=0.05, CI -0.14 to -0.01, Mean Diff 0.07), but limitations in data precluded further analysis. Overall, the results showed a trend of improvement in all outcome measures. Measures of adherence (85.1%) and attendance (85.8%) were positive in older adults, with no study related adverse events noted, student attendance (96.4%) was also high. The qualitative results showed a broadly positive experience across both students and older adult participants with key themes emerging for older adults of: belonging, the unique experience of student leaders, sense of self and perceived benefits of experience. Student themes included: peer and personal learning experience, real life patients and integration with university life. Importantly, a novel relational aspect emerged within this experience, where value was gained not solely from the physical or educational content, but through meaningful intergenerational interactions between older adults and student leaders. This relational dimension fostered a sense of connection, purpose and mutual respect, representing a unique benefit not previously reported.
Consensus: Agreement was reached that the majority (84 of 89) international physiotherapy clinical education based learning outcomes aligned to the expected training and delivery of a student-led programme of OEP, and supports the broadly positive impact to students educational experience found in the main Feasibility study. These results support the potential for future curriculum embedded physiotherapy student-led OEP programmes.
Conclusion:
Overall, there is emerging, limited, but positive data for both the student educational experience and older adult outcomes following a student-led OEP for community dwelling older adults at risk of falls. A key novel contribution was the relational value older adults derived from meaningful interactions with student leaders—offering a form of care that extends beyond traditional healthcare interventions. This relational aspect highlights the potential for student-led programmes to deliver holistic, person-centred support.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Dawn Skelton (Supervisor), Sivaramkumar Shanmugam (Supervisor) & Fiona Kennedy (Supervisor) |
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