Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people

Voshaar, Richard C. Oude; Banerjee, Sube; Horan, Mike; Baldwin, Robert C.; Pendleton, Neil; Proctor, Rebekah; Tarrier, Nicholas; Woodward, Yvonne; Burns, Alistair

doi:10.1017/s0033291706008270

Cited by 104 publications

(122 citation statements)

References 52 publications

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“…The literature review incorporated the principles of realist synthesis to identify the implicit or explicit theories that explain the mechanisms of interventions (how they are expected to work and why they work or did not work). [12][13][14][15] A survey of current services determined usual practice and was an additional source of relevant theories that contributed to the realist synthesis review. Focus groups with multidisciplinary rehabilitation teams, as well as hip fracture patients and their carers, informed the design of a complex multicomponent community-based rehabilitation programme ( Figure 1a).…”

Section: Methodsmentioning

confidence: 99%

“…[11][12][13][14] Fear of falling is present in at least half of patients following hip fracture. It is associated with loss of mobility, institutionalisation and mortality and is related to less time spent on exercise and an increase in falls.…”

Section: Objectivesmentioning

confidence: 99%

“…The review included a total of 22,443 patients and 97 health professionals. In total, 6282 (range 90-401) patients participated in RCTs, 12,69,78,80,87,[128][129][130]197,199 276 (range 24-95) patients participated in quasi-RCTs, 83,[131][132][133] 116 (range 20-30) patients participated in non-RCTs, 79,[134][135][136][137] 3044 (range 1-919) patients participated in historical cohort studies, 13,[157][158][159][160][161][162][163][164][165]170,173,178 7136 (range 18-946) patients participated in concurrent cohort studies, 81,[138][139][140][141][142][143][144][145][146][147][148][149][150][151][152]169,177,179,…”

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

“…185 Eight studies included patients aged ≥ 50 years; 87,98,103,118,173,187,188,192 18 studies included patients aged ≥ 60 years; 12,89,96,104,114,117,119,122,132,133,149,154,164,[193][194][195][196][197] 19 studies included patients aged ≥ 70 years; 69,72,79,88,106,108,110,111,116,120,131,136,143,148,150,161,180,183,184 and seven studies included patients aged ≥ 80 years. 13,81,123,134,137,152,178 The age of the included participants could not be determined from the study reports for four studies.…”

Section: A Community-based Multidisciplinary Rehabilitation Package Fmentioning

confidence: 99%

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Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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Section: Methodsmentioning

confidence: 99%

Section: Objectivesmentioning

confidence: 99%

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

Section: A Community-based Multidisciplinary Rehabilitation Package Fmentioning

confidence: 99%

See 2 more Smart Citations

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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“…This reduced confidence in one's abilities contributes to the cycle of sedentary lifestyle and disability. In fact, fear of falling was found to be more important than pain and depression when predicting functional recovery after hip fracture surgery in older adults [10]. Improving balance function has long been a major focus of stroke rehabilitation; however, the role that exercise may play in reducing falls and improving bone health in people with stroke is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Balance, falls, and bone health: Role of exercise in reducing fracture risk after stroke

Eng

Pang

Ashe

2008

JRRD

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Abstract-Fractures occur frequently in people living with stroke and have high personal, social, and economic costs for these individuals, their families, and the community. Exercise to reduce the risk of fragility fractures is a relatively new application in stroke rehabilitation but is a promising treatment with the potential to reduce the incidence of falls as well as maintain or improve bone health. In this article, we outline fracture risk factors and provide an overview of exercise interventions aimed at reducing fracture risk poststroke. Although randomized controlled trials support the use of exercise to reduce fracture risk factors poststroke, the body of literature is small and further studies are required. Further, the optimal dose of exercise and the additive effects of pharmacology on fracture risk need to be determined. Given the many health benefits associated with exercise, it should be considered an important modality for the management of falls and maintenance of bone health following stroke.

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Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people

Crotty

Unroe

Cameron

et al. 2009

Cochrane Database of Systematic Reviews

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To evaluate the short (four months or less) and longer term effects of interventions, including programmes, specifically aimed at improving and restoring physical and psychosocial functioning after a hip fracture in older people. The primary comparison will be between any relevant intervention versus no or placebo (sham) intervention, or conventional or usual care. 1 Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people (Protocol)

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Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people

Abstract: Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

Cited by 104 publications

References 52 publications

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Balance, falls, and bone health: Role of exercise in reducing fracture risk after stroke

Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people

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