Salekar Shraddha, Khandale Sanjivani Ramesh; International Journal of Advance Research and Development

(Volume 4, Issue 4)
Available online at: www.ijarnd.com

Effect of Otago exercise program on balance and risk of fall in

community-dwelling individuals having knee osteoarthritis
Shraddha Salekar1, Dr. Sanjivani Ramesh Khandale2
1
Student. L. S. F. P. E. F College of Physiotherapy, Nigdi, Pune, Maharashtra
2
Assistant Professor, L. S. F. P. E. F College of Physiotherapy, Nigdi, Pune, Maharashtra

ABSTRACT
Aim: To study the effect of Otago exercises program on balance and on the risk of fall in community-dwelling individuals having
knee osteoarthritis. Purpose: Otago exercise program is an individually tailored home-based programme which will help the
elderly to reduce fall risk. Hence we are going to check whether Otago exercise program is helpful in reduction of fall and improve
balance in community-dwelling individuals having knee osteoarthritis. Study Design: – Experimental Study. Procedure: Consent
of the patients will be taken. The importance of the Otago exercises will be explained to the patient. The procedure and treatment
duration will be explained. Firstly at the first-week score of Time up and Go Test and Berg Balance Scale will be noted
Intervention for 1 month will be given. Lastly, at the 4th week again the scored will be checked. Result: The result of the Berg
Balance Scale shows, Mean pre-intervention was 36.77 and post-intervention was 45.7, P=0.0001 and t= 9.466. The result of time
up and go test shows, Mean pre-intervention was 40.87 and post-intervention was 28.07, P=0.0001 and t= 17.147 After comparing
within the group it is observed that pre and post-intervention were considered to be significant. Conclusion: According to the
findings of my study we conclude that Otago exercise program is effective in increasing strength and balance. Thus it is effective in
reducing the risk of fall in the older adult.

Keywords— Otago exercise program, Balance, Strengthening, Berg balance scale, Time up and go test
1. INTRODUCTION
Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality, and use
of health services including premature nursing home admissions. 1Alterations in the ability to execute smooth, accurate, controlled
motor responses occur with aging. The importance of understanding the basis of these changes is reflected in the large and ever-
expanding body of literature devoted to examining a various aspect of motor performance in older adults.2 The Otago Exercise
Program is an individually tailored, home-based balance and strength fall prevention program. It was developed by John and Clare,
Ph.D., researchers at the University of Otago in New Zealand and the New Zealand Falls Prevention Group.3 This programme is
unique in its clearly defined prescription and ability to be readily implemented across the community. Most of these falls are
associated with one or more identifiable risk factors (e.g. weakness, unsteady gait, confusion, and certain medications.3 Diminished
strength is well documented in the elderly. Sarcopenia refers to an age-associated loss of skeletal muscle mass decreased cross-
sectional area) as well as changes in the ability of muscle tissue to regenerate .2,3 This loss has a direct impact on strength, endurance,
mobility, the ability to perform smooth control motor responses . 2 Falls include dropping from a standing position or from exposed
positions such as step ladders According to the WHO global report on fall prevention in older age, risk factors for falls involve
biological, environmental, behavioral and socioeconomic factors. 2 Most common predictors of falls are abnormalities in gait or
balance and a past history of fall.3 Osteoarthritis (OA) is a chronic disease that can change the lifestyle of the affected person by
producing pain and decreasing function; OA can result in loss of mobility, pain, disability, and dependence.4Biomechanical,
immunologic, and biochemical factors are involved in cartilage destruction, which is at the core of OA; growth factors may play a role
in the body’s attempts to repair cartilage through cartilage synthesis. 4 Excessive wear and tear changes on joints contribute to OA
development; secondary nonspecific inflammatory changes in the joints also may contribute, so the former term “degenerative joint
disease” is no longer used for OA. In early OA, increased chondrocyte metabolism leads to the increased proteolytic breakdown of the
cartilage matrix. Fibrillation and erosion of the cartilage surface ensue and proteoglycan and collagen fragments are released into the
synovial fluid, stimulating a chronic inflammatory response in the synovium; metalloproteinases and cytokines produced by synovial
macrophages can diffuse back into the cartilage and directly or indirectly destroy tissue. Other proinflammatory molecules may also
be a factor. In addition to a breakdown of the articular cartilage, OA involves the entire joint complex, including synovium and

© 2019, www.IJARND.com All Rights Reserved Page | 36

 Salekar Shraddha, Khandale Sanjivani Ramesh; International Journal of Advance Research and Development
subchondral bone. Grossly, cartilage fissuring, pitting, and erosion are seen and can progress to the point that large areas of the joint
surface are denuded of cartilage; bone underlying denuded cartilage becomes sclerotic. Simultaneously, cartilage and bone proliferate
(a self-repair attempt), especially at the joint margin, leading to marginal osteophytosis. Genetic factors, obesity, and decreased bone
density may make OA more likely to occur.4 Impaired balance and increased postural sway ( oscillating movements of the body over
feet during relaxed standing) both occur with advancing age8.In my study for assessment of fall and balance we are using 1)Time Up
and Go test and 2) Berg Balance Scale. (2) Time Up and Go test is used to assess a person’s mobility and requires both static and
dynamic balance. Berg Balance Scale is to measure balance among older people with impairment in balance function by assessing the
performance of functional tasks which has a 14-item scale designed to measure the balance of the older adult. 2

2. RESULTS
The result of the Berg Balance Scale shows, Mean pre-intervention was 36.77 and post-intervention was 45.7, P=0.0001 and t= 9.466.
The result of time up and go test shows, Mean pre-intervention was 40.87 and post-intervention was 28.07, P=0.0001 and t= 17.147
After comparing within the group it is observed that pre and post-intervention were considered to be significant.

3. DISCUSSION
After completion of my study we observed that 4 weeks of Otago exercise program is useful in the treatment of elderly having fall
risk. For the prevention of fall, not only balance but also strength training is important. For the elderly, with proper instructions and
guidance, the exercises were carried out. Osteoarthritis is the most common joint disease that affects the elderly and age is one of the
most important risk factors for the disease.4 Synovial fluid is the fluid that surrounds the joints. it helps to protect cartilage which is the
tissue that covers the ends of the bones against damaged caused by friction during movement. 4Strengthening and balance exercises
mainly lower limb strengthening is cost-effective in the prevention of fall. For walking, both static and dynamic balance is needed.
Due to which ability to maintain the projection of body’s center of mass within manageable limits of base of support is essential.3 As
the effects of aging are considered, systems like sensory, central processing, neural pathways for motor control and musculoskeletal
system enabled the contribution of physiologic systems to be evaluated. Diminished strength is a well-documented finding in the older
adult. So the study proved that along with balance strength is also an essential element of fall prevention.

The balance consists of ongoing postural adjustments and anticipatory and thus a coordination task. Spink et al said that exercises that
focused on muscles of ankles and feet were considered to be important components of successful podiatry fall prevention trial.3The
study conducted basically aimed at lower limb strength training and postural muscles. Balance retraining, minimal upper extremity
and walking use delivered at a moderate intensity to achieve results. The changes were expected in order to reduce fall risk as
moderate intensity strengthening and balance retraining exercises were provided to the elderly. To challenge the elderly more, walking
was been implemented lastly in order to serve the purpose to reduce accidental falls. 3 Otago showed increased in lower limb strength
and balance they were improved by walking and turning around, heel to toe walking and stair walking. These factors are important
predictors or causes of walking. In addition, through stair walking, the patient practiced with fixed foot support, acceleration, balance
control, contraction of the lower limb and ankle dorsiflexion to move the center of gravity to control the afferent, efferent, and
contraction of lower limb muscles. By improving the parameters there can be a drastic change in the pattern of walking and help gain
confidence in the elderly while walking.3

TIME UP AND GO TEST

45 40.87
40
35
30 28.07

25
20
15
10
5
0
PRE 1 POST 2

Fig. 1: Time up and go test

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 Salekar Shraddha, Khandale Sanjivani Ramesh; International Journal of Advance Research and Development

50 BERG BALANCE SCALE

45
40
35
30
25
20
15
10
5
0
1 2
Fig. 2: Berg balance scale

4. CONCLUSION
According to the findings of my study we conclude that Otago exercise program is effective in increasing strength and balance. Thus it
is effective in reducing the risk of fall in the older adult.

5. ACKNOWLEDGMENT
The satisfaction that accompanies the successful completion of any task would be incomplete without mentioning of people whose
ceaseless co-operation, guidance and encouragement crown all the efforts with success.

I would like to thank God, my parents and my guardians for their undying support and for being the guiding stars in my life. I also
wish to express my feelings of gratitude, respect and affection to all my esteemed professors for helping me in this venture.

I am deeply indebted to Dr. Sanjivani Khandale, Professor of Community Based Rehabilitation and Project Guide, Late Shri
Fakhirbhai Pansare Education Foundation’s College of Physiotherapy, Pune for this invaluable guidance and support, who has
contributed her expertise in bringing out the best of me in this piece of project work.

I offer my regard to all those who supported me in any respect during the completion of the study. Last, but not least, I express my
sincere thanks to all the subjects who participate and gave their full co-operation for the study.

6. REFERENCES
[1] Laurence Z Rubenstein: Falls in older people: epidemiology, risk factors, and strategies for prevention.
[2] Sullivan, Examination of Co-ordination and Balance Physical Rehabilitation: Chapter 6- page no 215 edition 6th.
[3] Dr. Deepti Wadhwa and Dr. Deepali Hande: Effectiveness of the Otago Exercise Program on Reducing the Fall Risk in Elderly:
Single Case Report. Imperial Journal of Interdisciplinary Research(IJIR) Vol-2,Issue-6,2016,ISSN:2454-1362,
http://www.onlinejournal.in
[4] Kevin M Means and Patrick M. Kortebein: Geriatrics: Musculoskeletal: Osteoarthritis-page no 120
[5] Honor Whiteman: Why is Osteoarthritis more common among women? Study sheds light
[6] Podsiadlo D. and Richardson. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. A G S. 1991; 39
(2); 142-148.
[7] Otago Exercise Program Activity Booklet.44-79.
[8] Sherrington C, Whitney J, Lord S et al. Effective Exercise for the Prevention of fall: A Systematic Review and Meta-Analysis.
Journal of the American Geriatrics Society.2008; 56, 2234-43.
[9] Viccaro L .J, Perera S, Studenski S.A. Is Timed Up and then gait speed in predicting health, function and falls in older adults? J of
the AGS. 2011; 59(5):887-892
[10] Sebastian K.A WHO Global Report on Falls among Older Persons.1-31
[11] Sullivan, et al: Berg Balance Scale Physical Rehabilitation: Appendix 6: A pg 247-248
[12] Tinetti, M, Richman, D, and Powell, L: Falls efficacy as a measure of fear of falling. J Geronotol 45: P239-P243, 1900.

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