TIME™ at Home Feasibility Study: Evaluation of a Virtually Delivered, Community-based, Task-oriented Exercise Program
- Conditions
- Mobility LimitationBalance Impairment
- Interventions
- Other: TIME™ at Home
- Registration Number
- NCT05369741
- Lead Sponsor
- University of Toronto
- Brief Summary
Balance and mobility limitations can lead to increased difficulty with everyday function and increased dependence on caregivers. Adults with balance and mobility limitations need access to safe and beneficial exercise programs to maintain or improve their health. Task-oriented exercise programs designed for adults with balance and mobility limitations incorporating a healthcare-community partnership, are safe and feasible to implement in the community setting. In this model, trained fitness instructors deliver the exercise program, and a registered healthcare professional in a healthcare partner role provides ongoing support through class visits, email communication with instructors, and program referrals. One example is Together in Movement and Exercise (TIME™) program which was developed by physical therapists at the Toronto Rehabilitation Institute, University Health Network (TRI-UHN). Research has shown that the in-person TIME™ program has the potential to improve everyday function, independence, and social participation in people with neurological conditions. Virtual delivery of these programs is needed to address barriers to attending in-person exercise programs. Barriers can include inadequate access to transportation, inclement weather, distance to community centres, and community centre closures during pandemic situations.
This is a before-and-after study to evaluate the potential benefit, safety, and feasibility of the virtual TIME™ program (called at TIME™ at Home), delivered using a group-based, 8-week program format, among people with balance and mobility limitations. Also, the aim is to describe the experiences of participants, caregivers, healthcare partners, and program facilitators and coordinators with the program to make recommendations for improvement.
- Detailed Description
Balance and mobility limitations can adversely affect everyday functioning and accelerate dependence on caregivers leading to institutionalization. Previous literature has suggested that a group, task-oriented community-based exercise program (CBEP), targeting balance and mobility (i.e., capacity for walking, transfers, sit-to-stand, stairs), implemented through an innovative healthcare-community partnership (CBEP-HCP), has the potential to improve everyday function, independence and social participation in persons with stroke. The Together in Movement and Exercise (TIME™) program is a licensed, group, task-oriented community-based exercise program incorporating a healthcare-community partnership for adults with balance and mobility limitations. Physical therapists at the Toronto Rehabilitation Institute, University Health Network (TRI-UHN), developed the TIME™ program. Trained fitness instructors deliver the exercise program face-to-face (in-person) in community centres and a healthcare professional who serves as a healthcare partner provides ongoing support. The program has been offered in over 50 community centres across Canada.
Virtual delivery of CBEP-HCPs is needed to address barriers to attending in-person exercise programs among people with balance and mobility limitations. Barriers can include inadequate access to transportation, inclement weather, distance to community centres, and community centre closures during pandemic situations.
During the COVID-19 pandemic, the investigators used an iterative process to develop an online version of the TIME™ program, called TIME™ at Home. TIME™ at Home is a standardized, community-based program licensed by the UHN involving the delivery of video-based task-oriented exercises. The exercises in the video were adapted from the classic in-person TIME™ program and were considered safe for people with balance and mobility limitations to perform at home. In addition to a warm-up and cool-down, the video shows a physical therapist and an occupational therapist performing each exercise at two difficulty levels. Participants are asked to self-pace and self-select the difficulty level that feels right for them. A trained facilitator at a community organization streams the video for people with balance and mobility limitations using Zoom.
The TIME™ at Home program, due to its virtual nature, has potential to improve exercise participation in remote and isolated settings. Unlike the in-person program, it does not require participants to be physically present at a community centre, thus eliminating some common barriers like lack of (adaptive) transportation, difficulty with transportation during inclement weather, long travel times to community centres from rural settings, and inadequate building access. The program can be delivered at home with minimal equipment. Also, the program involves showing standardized exercise videos developed by physical therapists and occupational therapists at TRI-UHN which prevents the need to train fitness instructors to deliver the program. Therefore, TIME™ at Home has potential for reducing barriers encountered with delivering in-person standardized exercise programs in community-based settings.
Pilot research to date on the TIME™ at Home Program (Virtual Program)
Program developers at TRI-UHN in collaboration with our research group have evaluated the feasibility of components of the virtual TIME™ at Home Program in partnership with the Multiple Sclerosis Society of Canada and Abilities Centre in Whitby (Ontario). Findings support the safety of delivering TIME™ at Home using a drop-in format. The safety, feasibility, and potential benefit of a group-based format, class visits from a healthcare partner, and a post-class social time to facilitate social support, have not been comprehensively evaluated.
Thus, the study objectives are:
1. To evaluate the feasibility, safety, and potential to improve everyday functioning, lower extremity strength, functional mobility, balance self-efficacy, mood, caregiver mood, and perceived health status, of an 8-week, group, virtual, task-oriented community exercise program called TIME™ at Home, among people with balance and mobility limitations.
2. To describe the experiences of exercise participants, caregivers, healthcare partners, and program facilitators and coordinators with TIME™ at Home (using qualitative data collection and analyses).
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 20
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description TIME™ at Home TIME™ at Home TIME™ at Home is a licensed, pre-recorded video-based, group, community exercise program. One program will have a maximum of 10 participants registered. March of Dimes Canada will run two programs. A 1.5-hour session will be hosted by two facilitators using Zoom twice a week for 8 weeks, starting with the Level 1 video (beginner level). All participants will switch to the Level 2 video (advanced level) mid-program.
- Primary Outcome Measures
Name Time Method Change in Subjective Index of Physical and Social Outcome for exercise participants 0 and 8 weeks Self-report measure of everyday functioning, scoring range 0-40, higher scores are better.
- Secondary Outcome Measures
Name Time Method Change in EuroQuol Visual Analogue Scale for exercise participants 0 and 8 weeks Self-report measure of perceived health status, scoring range 0-100, higher scores are better
Change in Activities-Specific Balance Confidence scale for exercise participants 0 and 8 weeks Self-report measure of balance self-efficacy, scoring range 0-100, higher scores are better.
Change in Center for Epidemiological Studies Depression scale for caregiver 0 week and 8 weeks Scores range from 0 to 60, with high scores indicating greater depressive symptoms.
Change in 30-second sit to stand test (30STS) for exercise participants 0 and 8 weeks A performance-based test which measures lower extremity strength and dynamic balance. It is measured by the number of times a person comes to a full standing position from a chair in 30 seconds.
Change in Timed Up and Go (TUG) test for exercise participants 0 and 8 weeks A performance-based test which measures functional mobility. The time taken to stand in seconds from a standard chair, walk 3 metres, turn around, return to the chair, and sit down is documented.
Change in Center for Epidemiological Studies Depression scale for exercise participants 0 and 8 weeks Scores range from 0 to 60, with high scores indicating greater depressive symptoms.
Feasibility outcome: adverse events 8 weeks 0% of the participants will report a serious adverse event, defined as an event that leads to death, a life-threatening adverse event, inpatient hospitalization or a persistent or significant disability or incapacity that lasts more than 48 hours and limits activities of daily living
Feasibility outcome: acceptability of the facilitator 4 and 8 weeks 90% of the participants will report that the facilitator was encouraging
Feasibility: intervention fidelity Week 5 and 8 Checklist completed by a member of the research team
Feasibility outcome: attendance Each class, i.e. twice a week for eight weeks 70% of the participants will attend at least 75% of the classes (i.e., 12)
Feasibility outcome: acceptability of the social component 4 and 8 weeks 60% of the participants will report participating in the social time before and after the exercise video
Feasibility outcome: acceptability of the healthcare partner 8 weeks 80% of the participants will report they found the healthcare partner e-visits useful
Feasibility outcome: acceptability of the Level 2 video 8 weeks 80% of the participants will find the video easy to understand and follow
Feasibility: Healthcare partner feedback questionnaire Week 2, 5 and 8 To describe the program experiences
Trial Locations
- Locations (2)
March of Dimes Canada (Halifax)
🇨🇦Halifax, Nova Scotia, Canada
March of Dimes Canada (Toronto)
🇨🇦Toronto, Ontario, Canada