Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention (“Step by Step”) and evaluated in a RCT.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = −0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes “perceived ability to manage falls” (P = 0.031, d = 0.41), “physical performance” (short physical performance battery) (P = 0.002, d = 0.58) and a lower “number of falls” (P = 0.029, d = −0.45).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.</jats:p> </jats:sec>

Change of physical activity parameters of hip and pelvic fracture patients during inpatient rehabilitation and after discharge: analysis of global and in-depth parameters

“…The current study is a secondary, explorative data analysis of a randomised controlled trial that aimed to improve PA and fall-related self-efficacy in hip and pelvic fracture patients [ 22 , 23 ]. Participants were recruited between April 2011 and December 2013 from one geriatric rehabilitation facility in the Southwest of Germany.…”

Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis

“…There was insufficient information to assess allocation concealment for 7 RCTs. Lack of blinding of personnel and participants was the most common reason for high bias assignment (n = 5) [24][25][26][27][28][29]. In addition, one RCT did not blind outcome assessors [24,25].…”

“…Detailed characteristics for the 11 RCTs are available in Table 1. RCTs were completed in Australia (n = 1) [29], Finland (n = 1) [30], Germany (n = 2) [26,31], the Netherlands (n = 1) [32], Sweden (n = 2) [24,25,28] and the USA (n = 4) [27,[33][34][35]. Sample size ranged from 28 [31] to 240 participants [32].…”

“…Sample size ranged from 28 [31] to 240 participants [32]. Participants were older adults (eligible age range from 60 years plus [26,30,33] to 75 years plus [31]) admitted with hip fracture and treated surgically. Nine RCTs excluded potential participants based on their cognitive function [24-27, 29-32, 34, 35].…”

“…Karlsson et al [28] explicitly stated inclusion of participant irrespective of cognitive status, whilst Magaziner et al excluded participants with 'low potential to benefit' or 'practical impediments to participation' [33]. Participants were recruited from acute hospital [24,25,28,29,34,35], inpatient rehabilitation [26,31], clinic/health centres [27,33], nursing and community care facilities [32] or the community [30]. Outcome assessments were completed by physiotherapists [27,30,33], occupational therapist [24,25,32], gerontologist and psychologist [26], researchers [28] or were not specified [29,31,34].…”