Physical Activity, Physical Function and Fear of Falling After Hip Fracture

Achterberg, Wilco P.

doi:10.24966/orp-2052/100031

Cited by 4 publications

References 25 publications

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Patterns of Physical Activity Over Time in Older Patients Rehabilitating after Hip Fracture Surgery: A Preliminary Study

Dartel

Wang

Hegeman

et al. 2022

Preprint

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Purpose: To investigate patterns of continuously monitored physical activity in older patients rehabilitating after hip fracture surgery and the association with patient characteristics. Methods: Physical activity of surgically treated hip fracture patients (≥70 years) was continuously measured during rehabilitation at a skilled nursing home using an accelerometer. The intensity of physical activity per day was calculated to describe patients′ activity. Physical activity patterns of overall activity, overall variability, and day-to-day variability were investigated. Two experts in geriatric rehabilitation visually identified unique physical activity patterns for each aspect. Eighteen healthcare professionals independently classified each patient in one of the predefined patterns for each aspect. Differences between physical activity patterns and patient characteristics were assessed using a Kruskal-Wallis or Fisher′s Exact Test. Results: Data from 66 patients were used. Six unique patterns were identified for overall activity and overall variability, and five for day-to-day variability. The most common pattern of overall activity and day-to-day variability first slowly increased, then steeply increased, and subsequently flattened (n=23,34.8%). For overall variability, the most common pattern first slowly increased, then steeply increased, then decreased and lastly increased (n=14,21.2%). Differences in functionality at rehabilitation admission, measured with the Barthel Index, and duration of rehabilitation stay were found between patterns of physical activity. Conclusions: This preliminary study showed different patterns of physical activity among older hip fracture patients during rehabilitation. Functionality at rehabilitation admission and duration of rehabilitation stay were associated with these different patterns. Differences in physical activity patterns emphasize the importance of personalized hip fracture treatment.

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Patterns of Physical Activity Over Time in Older Patients Rehabilitating after Hip Fracture Surgery: A Preliminary Study

Dartel

Wang

Hegeman

et al. 2022

Preprint

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Association of the @ctivehip tele-rehabilitation with the fear of falling of older adults with hip fracture and their family caregivers: Secondary analysis of a non-randomised controlled trial

Prieto-Moreno,

Molina-García,

Ortiz-Piña

et al. 2024

J Telemed Telecare

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Introduction Osteoporotic hip fracture is a major health problem. Falls, the primary cause, might lead to a persistent fear of falling (FoF) among older adults, affecting their daily activities and rehabilitation. While in-person interventions exist, limited research is available on the effects of tele-rehabilitation on the FoF after a hip fracture. Thus, this study aims to test the association of the @ctivehip tele-rehabilitation programme on reducing the levels of FoF experienced by both older adults with hip fracture and their family caregivers. Methods A non-randomised controlled trial (ClinicalTrials.gov; Identifier: NCT02968589) that compared a webpage-based tele-rehabilitation (@ctivehip) against usual care. Fear of falling was assessed using the Short Falls Efficacy Scale-International. Patients’ functional status was evaluated using the Functional Independence Measure. Physical performance was assessed by the Timed Up and Go test and Short Physical Performance Battery. We conducted a per-protocol analysis as the primary outcome, and an intention-to-treat approach as secondary analysis. Results A total of 71 patients with hip fracture (78.75 ± 6.12 years, 75% women) and their family caregivers participated. Participants in the intervention showed a higher decrease in FoF in comparison to those in the usual care (0.5 Cohen's d; p = 0.042). The reduction in FoF resulting from participation in the tele-rehabilitation programme was mediated by improvements in functional status by 79%. The @ctivehip programme did not decrease FoF of family caregivers. Discussion @ctivehip is associated with a reduction of the FoF in older adults with hip fractures, but not in their family caregivers, with the reduction being mostly explained by improvements in the patients’ functional status. Although the intervention seems promising, it should not be applied in clinical settings until confirmed by appropriate-designed randomised clinical trials.

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A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions

Gadhvi,

Bean,

Rice

2023

BMC Geriatr

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Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? Methods A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively. Results 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. Conclusion FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice. Trial registration PROSPERO registration: CRD42020221836.

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Physical Activity, Physical Function and Fear of Falling After Hip Fracture

Abstract: BackgroundPhysical activity and physical function are reduced after hip fracture and Fear of Falling (FOF) is common. However, relationships between these factors have not been investigated in elderly persons rehabilitating after hip fracture.

Cited by 4 publications

References 25 publications

Patterns of Physical Activity Over Time in Older Patients Rehabilitating after Hip Fracture Surgery: A Preliminary Study

Patterns of Physical Activity Over Time in Older Patients Rehabilitating after Hip Fracture Surgery: A Preliminary Study

Association of the @ctivehip tele-rehabilitation with the fear of falling of older adults with hip fracture and their family caregivers: Secondary analysis of a non-randomised controlled trial

A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions

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