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population in the near future will have many individuals experiencing a decline in these and
possibly additional client factors. Therefore, in order for older adults to age healthier and
maintain a quality of life, additional research studies must be conducted. By understanding the
factors affecting community mobility in older adults it will help develop evidence-base
interventions that will promote older adults to safely interact with their outdoor environment.
Ultimately, the preservation of an older adults community mobility will greatly prevent their
chances of developing disabilities, diseases, and injuries (Peterson, 2011).
There are multiple interventions that occupational therapists (OT) subscribe to that help
older adults maintain their community mobility. For example, older adults who are at risk or
those who already have had a fall incident when performing functional mobility, an OT may
recommend that these individuals join a fall prevention program such as the Otago Exercise
Program or Tai Chi: Moving for Better Balance (Peterson, 2011). The Otago is a home-based,
individualized exercise program that was designed to improve balance and increase lower limb
strength. A meta-analysis of the Otago has shown it to reduce falls and fall related injuries by
35% (Peterson, 2011). Tai Chi: Moving for Better Balance is an alternative exercise program that
emphasizes weight shifting, postural alignment, and coordinated movements with synchronized
breathing. Studies have been conducted and have demonstrated the Tai Chi program to improve
functional balance, strength, flexibility, and the reduction of fall risks (Peterson, 2011). Solely,
based off of the two programs intervention approach, they seem to differ greatly with one
another. However, the two programs underlying philosophy of using exercise as a means of
preventing the decline of community mobility amongst older adults is similar. Therefore, the
implementation of long-term physical exercise programs can be beneficial to improve older
adults community mobility.
mobility. However, many older adults may not have insurance coverage that extends to long
periods of occupational therapy rehabilitative services. Therefore, home and community exercise
programs could be recommended to individuals who want to continue maintaining a long-term
physical exercise program that could enhance community mobility. A long-term physical
exercise program that improves community mobility in older adults will provide clients with
accessibility to the community and improve engagement in community activities.
Healthcare delivery and policy:
Results from these studies should be used to inform policy makers that there is a great
need for an increase in occupational therapy services to help improve community mobility
among older adults. With additional training, occupational therapist can implement a physical
exercise program in conjunction with occupation-based activities to enhance community
mobility and help maintain the independence of community-dwelling older adults. In addition,
benefits proven from the physical exercise programs, such as improving physical health, can
serve as a viable option for lowering health care costs. Specifically, several of the studies show
strong evidence that the interventions work to decrease risk for falls and injurious falls which
possibly could lead to hospitalization and an increase in health care costs. Therefore, the results
can be used to advocate funding for physical exercise programs that enhances community
mobility to help older adults maintain independence and continue aging in place.
Education and training of OT students:
Student entry-level knowledge includes only basic understanding of different physical
exercise programs utilized by occupational therapy. However, students have pertinent knowledge
on proper body mechanics and the bodys mechanisms needed to participate in physical exercise
programs. In addition, the use of outcome measures such as, Time Up and Go Test, Berg Balance
Scale, Portable dynamometer, and Chair Stand test is education that is also obtained at entrylevel. Lastly, students have also learned biomechanical interventions, such as simple physical
exercises used as physical modalities that could be implemented in a physical exercise program.
Refinement, revision, and advancement of factual knowledge or theory:
Further research is needed to determine if community mobility will improve due to the
benefits associated with long-term physical exercise programs. Although, the selected research
articles indicates improvements in various client factors and increased participation in daily
activities, it does not directly correlate to improvements in community mobility. In addition,
continuous follow up should be implemented in the research to determine long-term effects of
the interventions.
Review Process:
Selected a special issue topic from AOTA that dealt with a particular population,
intervention, and outcomes
Articulated and developed focused question in PIO format
Focused question with rationale was submitted and approved by instructor
Developed inclusion and exclusion criteria for comprehensive literature search
Received instructor feedback on inclusion/exclusion criteria for evidence table
Developed a key term and database table to organize comprehensive literature searches
Key terms and database table completed and submitted for instructor review
Online search for ten peer reviewed articles that correlated to the focused question
Each of the ten literature studies that were selected underwent a McMaster critical review
and were then submitted to the instructor for approval
The instructors feedbacks of the McMaster critical reviews were discussed in weekly
meetings
Evidence table completed and submitted for instructor review
Instructor provided feedback for evidence table
All peer-reviewed articles were summarized and put into CAT format
CAT was completed and submitted for instructor to review
Procedures for the Selection and appraisal of articles:
Inclusion Criteria:
Exclusion Criteria:
Systematic reviews
Level III-V articles
Adolescent or young adult population
Duplicate publications
Articles 15 years or older
Articles that did not meet any of the search categories: patient population, intervention,
and outcomes
Search Strategies:
Categories
Patient/Client Population
Intervention
Outcomes
Results of Search:
Summary of Study Designs of Articles Selected for Appraisal:
Level of
Evidence
Number of Articles
Selected
I
II
III
IV
V
Other
10
0
0
0
0
0
10
Levels IV and V
No Level IV and V studies were appraised
Other
No other additional studies were appraised
Articles Selected for Appraisal:
Binder, E. F., Schenchtman, K. B., Ehsani, A. A., Steger-May, K., Brown, M., Sinacore, D. R., &
Holloszy, J. O. (2002). Effects of exercise training on frailty in community-dwelling older
adults: results of a randomized, controlled trial. Journal of The American Geriatrics
Society, 50(12), 1921-1928. doi:10.1046/j. 1532-5415.2002.50601.x
Fahlman, M., Topp, R., McNevin, N., Morgan, A., & Boardley, D. (2007). Structured exercise in
older adults with limited functional ability. Journal of Gerontological Nursing, 33(6), 3239.
Hasegawa, R., Islam, M., Nasu, E., Tomiyama, N., Lee, S., Koizumi, D., & Takeshima, N.
(2010). Effects of combined balance and resistance exercise on reducing knee pain in
community-dwelling older adults. Physical & Occupational Therapy in Geriatrics, 28(1),
44-65. doi:10.3109/02703180903381086
Li, F., Harmer, P., Fisher, J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N. L. (2005).
Tai chi and fall reductions in older adults: a randomized controlled trial. Journal of
Gerontology, 60(2), 187-194. doi:10.3109/02703180903381086
Nishiguichi, S., Yamada, M., Tanigawa, T., Sekiyama, K., Kawagoe, T., Suzaki, M., Yoshikawa,
S., Abe, N., Otsuka, Y., Nakai, R., Aoyama, T., & Tsuboyama, T. (2015). A 12-week
physical and cognitive exercise program can improve cognitive function and neural
efficiency in community-dwelling older adults: a randomized controlled trial. Journal of
the American Geriatrics Society, 63(7), 1355-1363. doi:10.1111/jgs.13481
Pang, M., Eng, J., Dawson, A., McKay, H., & Harris, J. (2005). A community-based fitness and
mobility exercise program for older adults with chronic stroke: a randomized, controlled
trial. Journal Of The American Geriatrics Society, 53(10), 1667-1674.
doi:10.1111/j.1532-5415.2005.53521.x
Patel, A., Keogh, J. W., Kolt, G. S., & Schofield, G. M. (2013). The long-term effects of a
primary care physical activity intervention on mental health in low-active, communitydwelling older adults. Aging & Mental Health, 17(6), 766-772.
doi:10.1080/13607863.2013.781118
Sherrington, C., Lord, R. S., Vogler, M. C., Close C. J., Howard, K., Dean, L. (2014). A post-
hospital home exercise program improved mobility but increased falls in older people: a
randomized controlled trial. Plos One, 9(9): e104412. doi:10.1371/journal/pone.0104412
Sosnoff, J. J., Finlayson, M., McAuley, E., Morrison, S., & Motl, R. W. (2014). Home-base
exercise program and fall risk reduction in older adults with multiple sclerosis: phase 1
randomized controlled trial. Clinical Rehabilitation, 28(3), 254-263.
doi:10.1177/026921551350192
Yamada, M., Higuchi, T., Nishiguschi, S., Yoshimura, K., Kajiwara, Y., & Aoyama, T. (2013).
Multitarget stepping program in combination with a standardize multicomponent exercise
program can prevent falls in community-dwelling older adults: a randomized, controlled
trial. Journal of The American Geriatrics Society, 61(10), 1669-1675.
doi:10.1111/jgs.1253
Other References:
Peterson, E.W. (2011). Reducing fall risk: A guide to community-based programs. OT Practice,
16(18), 15-20.
Rantanen, T. (2013). Promoting mobility in older people. Journal of Preventive Medicine and
Public Health, 46(Suppl 1), S50S54. http://doi.org/10.3961/jpmph.2013.46.S.S50
Robnett H. R. (2008). Client factors and their effect on occupational performance in late life. In
S. Coppola, S. J. Elliott, & P. E. Toto (Eds.), Strategies to Advance Gerontology
Excellence: Promoting Best Practice in Occupational Therapy Self-Paced Clinical
Course (1st ed., pp.163-191). Bethesda: AOTA Press.