Aim Declining mobility impacts older adults, especially where physiotherapy access is limited. Telephysiotherapy offers a potential solution, but its effectiveness and cost-effectiveness in aged care remain unclear. The TOP UP study evaluated the effectiveness and cost-effectiveness of telephysiotherapy in improving mobility among older adults in aged care settings. It also assessed its impact on falls, pain, quality of life, and healthcare utilisation compared to a wait-list control.
Methods This hybrid type 1 effectiveness-implementation randomised controlled trial (2021–2023) included 242 aged care recipients (≥65 years) randomised to a 6-month telephysiotherapy program (TOP UP) or wait-list control. The intervention consisted of 10 Zoom physiotherapy sessions, caregiver assistance, and online exercise videos. Mobility was assessed using the Short Physical Performance Battery (SPPB) at 6 months. Healthcare utilisation and intervention costs were captured from trial records and facility data. Implementation outcomes evaluated feasibility and acceptability.
Results The intervention group (n=92) improved mobility, scoring 2.1 points higher on SPPB (95% CI 1.4–2.7, p<0.01); decreased risk of falling by 37% (Risk Ratio 0.63, 95% CI 0.43 to 0.92) and pain reduced by 1.08/10 points (95% CI -1.82 to -0.34). Quality of life improved by 6 points (EQ-5D-5L). Program endorsement was 94%, with an 18% enrolment rate and 77% completion rate. Intervention cost was $2,061 per participant, with lower healthcare costs in the intervention group ($5,978 vs. $7,044 control).
Conclusion Telephysiotherapy is a feasible, acceptable approach for older adults, improving mobility, reducing falls and pain, enhancing quality of life, and lowering healthcare costs.