referral: a comparison of smart and enhanced smartdocs.communityconnection.net/falls docs/falls...
TRANSCRIPT
Let’s make a SMART
referral: a comparison of
SMART and Enhanced
SMART
1
Jennifer McLellan & Andrea Cameron
Original SMART
Overview:
2
The SMART Program
SMART (Seniors Maintaining Active Roles Together) ® is an exercise program for community members 55+ who wish to improve their strength, balance and flexibility, regardless of their current physical ability.
The Original SMART Program
Evidence-based and accredited by Accreditation Canada
Fully funded by NSM LHIN- no cost to the participant
Community exercise classes, in-home exercises and healthy aging education classes
Specialized classes for Stroke, Parkinson Disease, Osteoporosis, Multiple Sclerosis and community members who are deaf
Across NSM LHIN there are over 300 classes running at 126 sites each week!
4
Inclusion Criteria
Community members 55+
Reside in NSM LHIN
Reside in Community/ Retirement Home (not LTC)
Must be able to participate and follow instructions to complete exercises
Referral Sources: anyone can refer & self referrals accepted – please contact the SMART coordinator in your area
Program Components
In Home: 1 session per week with a fitness leader/volunteer Client to complete the 15 exercises an additional 2 x
per week on their own for 12 weeks Significant waitlist - attend classes where possible
Exercise Classes: Retirement homes and community locations Classes run continuously through the year 45 minutes- 1 hour in duration
Program Components
Healthy Aging Education:
12 standardized education modules developed and delivered by regulated health professionals from the IRFP, VON and Osteoporosis Canada
12 2-hour sessions delivered across NSM LHIN in various locations
Contact Information
Barrie and area: 705-737-5044 ext. 221
Muskoka: 705-787-1996
Orillia and area: 705-326-7021
Collingwood, Wasaga Beach & Midland areas: 705-355-2200
Enhanced SMART
Overview
9
Enhanced SMART Pilot Project 10
An initiative of the Assess and Restore program & Rehab Care Alliance
Current gap in community-based rehabilitation programs for the frail elderly
The interdisciplinary team works with seniors at high risk for hospitalization or admission to LTC
Fully funded by NSM LHIN until March 2017- no cost to the participant
Inclusion Criteria
Aged 55+ & live in the Barrie or Orillia area
4 to 6 on the Clinical Frailty Scale
Restorative potential and a recent decline in functional ability
Designated Referral sources:
RVH, OSMH, IOOF Convalescent Care Program (CCP), Woods Park CCP, Muskoka Shores CCP, IRFP, CCAC Rapid Response Nurses, VON SMART, Aging Well Clinic and Dr. Young’s Geriatric Outreach Clinic
Program Components
Team: Kinesiologist, Physiotherapist, Occupational Therapist & fitness leaders (OTA/PTA designated)
Comprehensive intake and discharge assessments
Individualized client-centered care plans
Group or in-home exercises, falls prevention/healthy aging education & cognitive stimulation activities
Ongoing support and monitoring by the RHPs
30 day follow-up calls
Goal: progress clients to Original SMART or other community exercise programs
Class Structure
Builds on the Original SMART model to include progressive, evidence-based exercises with client-centered care plans
Two class locations in Barrie & two classes in Orillia running twice weekly for a maximum of 12 weeks
In-home: 1:1 with an exercise leader [1 hour of exercises]
Class: 1:6 ratio -Maximum of 12 participants with 1 exercise leader and 1 regulated health professional (RHP) [2 hours of exercise, education & cognitive stimulation]
Successes - Outcome Measures
Average Pre Average Post Average Gain
Barthel (/20) 16.9 18.2 1.29
Knowledge confidence
(/55)
36.6 48.4 11.8
QOL (/65) 49.5 55.8 6.3
CFS (1-7) 5 (Mildly Frail) 4 (Vulnerable) -1 (Less Frail by 1
category)
Tinetti (/28) 18 (High risk of falls) 21.5 (Moderate risk of falls) 3.5
Grip Strength Right (kg) 20.7 21.3 0.6
Grip Strength Left (kg) 19.4 20.2 0.8
30s STS Test (# reps) 2.5 3.6 1.1
Gait Speed Test (m/s) 0.42 (red flag) 0.67 (yellow flag) 0.25** (a Δ of 0.1m/s is
clinically significant)
COPM Performance (/10) 2.5 6.1 3.6** (a Δ of 2 is clinically
significant)
COPM Satisfaction (/10) 2.7 7.2 4.5** (a Δ of 2 is clinically
significant)
Contact Info:
Andrea CameronKinesiologist & Enhanced SMART Program ContactVON Canada Simcoe County Branch
Tel: 705-737-5044 ext. 248
Central IntakeFax: 705-330-3201Email: [email protected]
So, what is the
difference?
16
In-home Comparison
SMART Enhanced SMART
1 hour of exercises 1 hour of exercises, informal education and cognitive stimulation
1 x per week 2 x per week
Led by a FitnessLeader/Volunteer
Led by an OTA/PTA
12 weeks in duration Maximum of 12 weeks
Community Class Comparison
SMART Enhanced SMART45min. to 1 hour of exercises 1 hour of exercises
Classes run throughout the week at a variety of locations and times
Each class runs twice a week at the 3 locations: North Barrie, South Barrie and Orillia.
Led by a Fitness Leader/Volunteer/RKin
Led by an OTA/PTA and RHP (RKin, PTor OT)
No set ratio of leader : participant 1:6 max ratio of leader : participant
Classes run continuously Maximum of 12 weeks
Program consists of exercises Program consists of exercises, cognitive stimulation and education
Exercise Comparison
SMART Enhanced SMARTProgressive and Maintenance exercises for strength, balance and mobility
Rehabilitative and Progressive exercises for strength, balance and mobility
Evidence-based and accredited
Individualized client-centered care plans determined by PT/RKin
General Comparisons
SMART Enhanced SMARTReferrals:
Any referral source, including self referrals
Referrals: Designated sources
Inclusion Criteria:Community members 55+ in the NSM
LHIN
Inclusion Criteria: High-risk frail seniors with restorative
potential in Barrie/Orillia areas
Cost:Funded by LHIN – no cost for
participant
Cost:Funded by LHIN – no cost for
participant
Ongoing Program- base funding Pilot Project- funded until March 2017
Questions?
21