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Developing the Thai Lifestyle-integrated Functional Exercise (TLiFE) Programme: An Intervention to Prevent Falls among Older Adults in Thailand
[Thesis]. Manchester, UK: The University of Manchester; 2020.
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Abstract
INTRODUCTION: Falls are the leading cause of injuries in older adults in Thailand. Strong evidence shows that strength and balance exercise reduces risk and rate of falls among older adults. There is a need to develop a fall prevention exercise programme in the home setting, to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines, as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in Thai context (TLiFE) among older Thai adults. METHODS: This feasibility study comprised two phases. Phase one: A qualitative study was undertaken to obtain perspectives on aLiFE by conducting focus groups and in-depth interviews with community-dwelling older Thai adults aged 60 years and above, and semi-structured interviews with stakeholders in Thailand. Framework analysis was used to inform the modifications of aLiFE to TLiFE. Phase two: A feasibility randomised controlled trial (fRCT) of TLiFE was conducted among community-dwelling older adults aged 60-75, comparing the TLiFE intervention group with a usual care control group. Outcome assessments were completed at baseline, three, and six months. Participants undertook physical performance tests and completed questionnaires to identify demographic characteristics, medical conditions, history of falls, fear of falling, health status, attitudes to falls-related interventions, and exercise adherence. RESULTS: Findings from the qualitative study of 40 older adults and 14 stakeholders revealed positive views and allowed the modification of aLiFE to TLiFE, including the implementation of TLiFE activities suitable to the Thai cultural context. Based on the findings of the qualitative study, seven balance and eight strength TLiFE activities were taken forward, with some adaptations. We recruited a total of 72 older adults aged 60-75 (mean age 66 years; SD 4.48) into the fRCT, randomised to TLiFE (n=36) and Control (n=36). Recruitment lasted two months. Retention rate at the 6-month follow-up was high (91.7%). Participation in the TLiFE intervention group was good (82.9%). The majority of TLiFE participants were fully adherent to TLiFE at six-month follow-up (57.1%) or partially adherent (40.0%). There were no differences in fall incidence between the groups. Participant satisfaction with TLiFE was high. Acceptability questionnaires revealed that TLiFE was easy to perform in daily life, safe, and useful. No adverse events were reported. CONCLUSIONS: Results suggest that the TLiFE programme appears to be acceptable and safe to deliver to community-dwelling older Thai adults and it is feasible to conduct a larger RCT of TLiFE. This feasibility study provides important information for the planning of a future study, but it was not powered to detect a difference between groups. A further fully powered definitive RCT of TLiFE is needed, to evaluate long-term outcomes and cost-effectiveness, before it is integrated within the healthcare system in Thailand.