Comparison of Smartphone and Community-Based Delivery of the Otago Exercise Program for Fall Risk in Older Adults

Effectiveness of Smartphone-Based Versus Community-Based Otago Exercise Programs for Fall Risk Reduction in Community-Dwelling Older Adults: A Randomized Controlled Trial

The long-term goal of this project is to effectively bridge the research-clinic-community gap and to foster partnerships that support the implementation, utilization, and advocacy of evidence-based fall prevention programs in the older adult community. The Otago Exercise Program (OEP) is an evidence-based fall prevention program that has been shown to reduce falls and fall-related injuries among older adults. Traditionally, OEP is delivered in the home by a physical therapist and focuses on muscle strengthening and balance training. Despite its proven effectiveness, adherence and compliance rates have been low. The personnel and resource demands of program delivery, along with challenges in monitoring participant adherence, represent significant barriers to broader implementation. Alternative delivery systems using remote and community-based platforms may help address these limitations.

Specific Aim 1: To compare the effectiveness of two delivery modes of the Otago Exercise Program: a remotely delivered, home-based smartphone program and an in-person, community-based program.

Specific Aim 2: To examine the feasibility, acceptability, and usability of the Otago Exercise Program delivered through both smartphone-based and in-person formats.

Study Overview

• Status: Recruiting
• Conditions: Fall; Frail Elderly
• Intervention / Treatment: Behavioral: Smartphone-Based Intervention; Behavioral: Group-Based Intervention

Detailed Description

Thirty eligible participants will provide written informed consent prior to enrollment. In accordance with the World Guidelines for Falls Prevention, participants will be stratified into low-, intermediate-, and high-risk groups. Following the first visit assessment, older adults classified as intermediate or high risk will be randomly assigned to one of two intervention groups: (1) a remotely delivered, smartphone- based Otago Exercise Program, or (2) an in-person, community-based Otago Exercise Program.

Participants in both groups will receive individualized 60-minute training sessions, two times per week for eight weeks. Across the sixteen training sessions, participants will receive a progressive balance, mobility, and strengthening program following the structure of the Otago Exercise Program.

Prior to and immediately following the exercise program, participants are asked to complete several surveys and evaluations, including: demographics, STEADI-12, SF-36, Geriatric Depression Scale (GDS), Falls Efficacy Scale-International (FES-I), Four-Square Stepping Test, Timed Up and Go Test (TUG), Ten-meter Walk Test, Four-Stage Balance Test, 30-second chair stand, and the Physiological Profile Assessment (PPA). All outcome measures will be collected at baseline and at the end of the intervention, with testers blinded to participant group allocation, and trainers blinded to baseline outcomes. In addition, gait speed will be assessed weekly using smartphone-based measurements.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Vipul Lugade, PhD; Phone Number: 16077774700; Email: vlugade@binghamton.edu
• Study Contact Backup: Name: Patima Silsupadol, PT, PhD; Email: patimas@binghamton.edu

Study Locations

• United States
  • New York
    • Binghamton, New York, United States, 13902
      • Recruiting
      • Binghamton University
      • Contact: Vipul Lugade, PhD; Phone Number: 6077774700; Email: vlugade@binghamton.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Community-dwelling older adults 55 years of age or older
• Communicate in English
• Able to ambulate at least 10 meters with or without an assistive device.
• Cognitively intact based on scoring 18/22 or greater on the Montreal Cognitive Assessment (MoCA)-Blind during a phone screening process
• Have access to an Android or iOS smartphone
• Intermediate or high risk of falling, based on World Guidelines for Falls Prevention (Montero-Odasso et al, 2022)

Exclusion Criteria:

• Lower limb amputation
• Visual impairment uncorrectable with lenses
• Uncontrolled hypertension, diabetes, neurological or musculoskeletal impairment
• Persistent symptoms of dizziness or lightheadedness
• Spine or lower-extremity surgery in the past 12 months
• Self-reported pain of >7 on a scale of 0-10

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Smartphone In-home Delivery; In-home 8-week OTAGO program	Behavioral: Smartphone-Based Intervention; Participants in the smartphone-based group will receive Otago Exercise Program instructions delivered through Improve, an investigator-developed application. This application, installed on each participant's iOS or Android smartphone, will allow participants to track their exercises and review workout instructions. Participants in the smartphone-based group will be contacted weekly by phone to ensure safety and adherence and to assist with troubleshooting any technology-related issues. All participants will be instructed to maintain their usual activity patterns and to refrain from initiating any new structured physical activity programs during the 8-week study period. Participants will be directed by Doctor of Physical Therapy students under the supervision of a licensed Physical Therapist, with weekly phone check-ins.; Other Names: Otago
Active Comparator: Group In-Person Delivery; In-Person 8-week Group OTAGO Program	Behavioral: Group-Based Intervention; Participants in the in-person, community-based group will complete the individualized Otago Exercise Program in a group setting at the Johnson City Senior Center, under the guidance of Doctor of Physical Therapy students (4) and supervision of licensed Physical Therapists.; Other Names: Otago

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait Velocity	Self-selected walking speed (m/s) over level surface	Baseline (Day 0) and 1 week post-training (9 weeks later)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Injurious Falls	Self-reported falls that lead to injury requiring clinical evaluation	Up to 1-year post intervention
PPA-Short Form: Postural Sway	Sway Area (units: mm^2) while standing quietly for 30 seconds	Baseline (Day 0) and 1 week post-training (9 weeks later)
PPA-Short Form: Finger Reaction Time	Simple reaction time (units: msec)	Baseline (Day 0) and 1 week post-training (9 weeks later)
PPA-Short Form: Knee Extensor Strength	Maximum isometric knee extensor force (kg)	Baseline (Day 0) and 1 week post-training (9 weeks later)
PPA-Short Form: Visual Contrast Sensitivity	Melbourne Contrast Sensitivity (db), on a scale of 0-24	Baseline (Day 0) and 1 week post-training (9 weeks later)
PPA-Short Form: Proprioception	Degrees offset in foot positioning	Baseline (Day 0) and 1 week post-training (9 weeks later)
30-second Chair Stand	Number of chair rises in 30-seconds	Baseline (Day 0) and 1 week post-training (9 weeks later)
TUG	Timed up and go test. Rise from a chair, walk 3-meters, turn, and return walk, and sit back down at self-selected speed	Baseline (Day 0) and 1 week post-training (9 weeks later)
Four-Stage Balance	Total time to stand in side-to-side, semi-tandem, tandem, one-leg stance.	Baseline (Day 0) and 1 week post-training (9 weeks later)
Smartphone-based assessments	Self-evaluated walking speed as performed by participants at home	Weekly during 8-week training program

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Four square step test	Time to complete a clockwise and counterclockwise stepping into four quadrants	Baseline (Day 0) and 1 week post-training (9 weeks later)
Frailty	Physical Frailty Phenotype, reported on a scale of 0-5. A higher score indicates increased frailty.	Baseline (Day 0) and 1 week post-training (9 weeks later)
Self-reported Assessment: Enjoyment	Participant report of enjoyment, usability, and feasibility of the exercise program (1-5 scale), where higher scores indicate increased self-report.	At study completion, or on average 1 week post-training
SF-36	Short-form health survey to evaluate participant self-reported health quality of life.	Baseline (Day 0) and 1 week post-training (9 weeks later)
STEADI	Self-report (0 to 14-point scale), where increased scores indicate increased fall risk.	Baseline (Day 0) and 1 week post-training (9 weeks later)

Collaborators and Investigators

• Sponsor: Binghamton University

Study record dates

Study Major Dates

• Study Start (Actual): February 16, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: February 15, 2026
• First Submitted That Met QC Criteria: February 24, 2026
• First Posted (Actual): February 25, 2026

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 24, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Balance; Smartphone; Falls; Stepping; Group Exercise; Otago
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Gait Disorders, Neurologic
• Other Study ID Numbers: STUDY00006790

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: No identifying information will be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No