Presenter(s):

Tianma Xu, Singapore Institute of Technology, Singapore

Abstract

Background: Frailty can result in adverse health-related outcomes, e.g., hospitalisations, falls, disability, and mortality. Based on Clinical Practice Guidelines for frailty management, a multicomponent frailty management program “Say No To Frailty (SNTF)” was developed for community-living older adults with frailty and pre-frailty in Singapore. The SNTF program led by a trained program facilitator has shown feasibility and exhibited a trend to facilitate personal behavioral changes with increased community participation post-intervention. This study aimed to evaluate the clinical effectiveness of SNTF on physical functions, self-confidence, community participation, quality of life and fall reduction in the local community setting.

Methods: We conducted a cluster-randomized clinical trial (c-RCT) study approved by the Institutional Review Board, Singapore Institute of Technology. Twelve community aged care centres were randomly assigned to three different arms (healthcare professional (HCP)-led SNTF program, non-HCP-led SNTF program, and usual care). The SNTF program comprises 12 weekly group sessions followed by a booster session and a phone call 1-month and 3-month postintervention, respectively. The weekly sessions involve a one-hour talk by healthcare professionals covering different topics. Thereafter, a 15-minute break is given to encourage social networking between participants, followed by 45-minute low-to-moderate intensity strength and balance exercises.

Participants were recruited via convenience sampling method and screened for eligibility at each participating site. All participants were followed up for one year and pre-post-assessments were conducted at the baseline, 3 months, 6 months and 12 months. Outcome measures include physical functions (Clinical Frailty Scale, Short Physical Performance Battery, hand grip strength), self-efficacy (Falls Efficacy Scale – International), community participation (Life-space Assessment, Goal Attainment Scale) and health-related quality of life (EQ-5D-5L). The outcome differences within- and between-group were analysed using mixed ANOVA.

Fall history in the past 6 months was collected at the baseline. Monthly fall data were collected via phone calls or face-to-face meetings during the study period. Fall-related information (e.g. pattern, location, injury) was recorded if a fall incident was reported. The fall rate pre- and during the study period was compared.

Results: As of October 2024, 93 participants (HCP-led groups:26; non-HCP-led groups:26; control group:41) from nine participating centres were followed up at 12 months. All six intervention groups showed significant improvement in all assessments immediately post-intervention and the effects were sustained for 9 months (p<.05). No significant group differences (between HCP-led and non-HCP-led groups) were observed for all measures at different time points (p>.05). Intervention groups had more significant health outcomes than the control groups (p<.05).

Fall rates in intervention groups decreased from 92 to 31 per 100 person-year during the one-year study period, whereas the control group had an increased fall rate from 34 to 56 per 100 person-year. No serious injuries were reported in all groups. More than 50% of fall incidents were due to environmental hazards.

Conclusion: The SNTF program had positive clinical effects in improving physical functions, self-efficacy, community participation and quality of life, and fall reduction regardless of the program facilitator’s training background. The clinical effects could last for 9 months.

Bio(s):

Dr. Tianma Xu (Tim) is an esteemed Occupational Therapy Associate Professor at the Singapore Institute of Technology (SIT) and holds a PhD in Health Sciences from the University of Sydney, Australia. He has over 24 years of experience working with older adults and the stroke population in Singapore and Australia. Dr. Xu is a pioneer faculty member in developing the 4-year occupational therapy degree program at SIT. He is an active researcher in aged care and stroke rehabilitation, with a focus on fall prevention and frailty management. His “Say No To Frailty” program has been listed in the National Frailty Strategy Policy Report published by the Singapore Ministry of Health and is currently being implemented in many Active Aging Centres in Singapore. Dr. Xu is also involved in several professional roles, including serving as a member of the Peer Review Group for Stroke to the development of the World Health Organization (WHO)’s Package of Interventions for Rehabilitation, a Community Rehabilitation Transformation Workgroup member at the Singapore Ministry of Health and an expert member of the Singapore Building Construction Authority, an editorial board member in several scientific journals, an SIT Institutional Review Board member.