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Pliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson PAC, Jiraporncharoen W, Angkurawaranon C. Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49482. [PMID: 38865706 DOI: 10.2196/49482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.
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Affiliation(s)
- Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Poppy Alice Carson Mallinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Baltes M, Stephan A, Andrich S, Meyer G. Development of Fear of Falling after proximal femoral fracture. Pflege 2024. [PMID: 38809228 DOI: 10.1024/1012-5302/a000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Background: Proximal femoral fracture is common in older people. Beyond a long recovery process and significant permanent functional limitations, older people often experience subsequent Fear of Falling. The phenomenon of Fear of Falling is not fully understood; qualitative research is underrepresented but can provide insights into the experience of those affected. Objectives: We aimed to explore the experiences of Fear of Falling development and to what extent it affects peoples' life after proximal femoral fracture. Methods: We conducted semi-structured, in-depth interviews with nine older people, aged between 61 and 88, who participated in a prospective observational study. Interview data were analysed through inductive content analysis. Results: Six major themes emerged: The development of Fear of Falling; the effect of FoF and hope for recovery; alternating between moments of fear and security; fear of helplessness and of losing independence; strategies for dealing with Fear of Falling and maintaining independence; need of support by health care professionals. Conclusion: To identify and support older people in coping with Fear of Falling (after proximal femoral fracture), strategies for dealing with Fear of Falling across occupational groups and all healthcare settings should be implemented. Nurses have a key role in this process.
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Affiliation(s)
- Marion Baltes
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Uniklinik RWTH Aachen, Germany
| | - Astrid Stephan
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Uniklinik RWTH Aachen, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Katz D, Geftler A, Abu-Ajaj A, Makulin E, Star E, Zikrin E, Shacham D, Velikiy N, Freud T, Press Y. Intensive rehabilitation after pelvic and hip fractures: a comparative retrospective study. Front Med (Lausanne) 2024; 11:1346354. [PMID: 38818387 PMCID: PMC11137187 DOI: 10.3389/fmed.2024.1346354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Pelvic fracture (PF) is common, especially among older patients, and its prevalence increases over time. In contrast to hip fracture (HF), the literature on rehabilitation after PF is scant, mandating a study of the outcomes of rehabilitation in patients with PF. The present study compared patients who underwent intensive rehabilitation following HF or PF. Methods A retrospective study of patients 65 years of age and older who underwent intensive rehabilitation in the Geriatrics Department. Data were collected on patients with PF, while data on patients with HF were taken from an earlier study. All patients in both groups suffered from low-energy trauma. Rehabilitation outcomes were measured using the Montebello Rehabilitation Factor Score-revised (MRSF-R). Results 144 PF patients were compared with 138 HF patients. The mean age of the patients in the HF group was 82.5 ± 7.1 compared to 81.5 ± 6.9 in the PF group (p = 0.230). Females comprised 77.5% of the patients in the HF group and 90.3% in the PF group (p = 0.04). All patients in the HF group underwent surgical repair of their fracture, while all patients in the PF group had non-surgical treatment. More patients in the HF sample had a nursing caregiver prior to the fracture (92.0% vs. 60.4%, p < 0.001), had a higher Charlson Co-morbidity Index total score (2.1 ± 1.9 vs. 1.6 ± 1.7, p = 0.13), developed more delirium (21.7% vs. 8.3%, p = 0.16), more infections (29.0% vs. 11.1%, p < 0.002), and more cardiovascular complications (23.9% vs. 5.6%, p < 0.001) during hospitalization. They had longer hospital stays (20.9 ± 7.5 vs. 18.2 ± 7.7 days, p = 0.0007), and had a higher mortality rate (13.8% vs. 6.3%, p = 0.037) over the first year following the fracture than the PF group. A similar rate of patients in both groups (64.5% vs. 60.4%, p = 0.483) had successful intensive rehabilitation. In the PF group only cognitive state was an independent predictor of successful rehabilitation, with each additional point in the Mini Mental State Examination (MMSE) increasing the patient's chance of reaching an MRFS-R score ≥ 50 by 20.5%. Conclusion Despite slightly different characteristics in the two groups, the results of intensive rehabilitation were similar. Cognitive state was the only independent factor that affected achievement of a better rehabilitation outcome. With the increasing rate of PF, more studies should focus on rehabilitation in this patient population.
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Affiliation(s)
- Dori Katz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Alex Geftler
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Orthopedics, Soroka Medical Center, Be'er Sheva, Israel
| | - Ahmed Abu-Ajaj
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Evgeni Makulin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Eva Star
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Evgeniya Zikrin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - David Shacham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Natalia Velikiy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yan Press
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Be'er Sheva, Israel
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Laizeau C, Jochmans S, Aufaure S. Pelvic joint stiffness and fear of falling in patients over 75 years of age: a prospective cohort study of 100 patients. J Osteopath Med 2024; 0:jom-2024-0004. [PMID: 38713850 DOI: 10.1515/jom-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/08/2024] [Indexed: 05/09/2024]
Abstract
CONTEXT A third of the population aged 65 and over experiences a fall during a given year, often with severe traumatic consequences, dependence, and consequently, a decline in quality of life. The fear of falling itself leads to avoidance behavior from daily activities leading to a downward spiral of dependence, loss of confidence, and therefore an increased risk of falling. Joint stiffness is often observed during clinical examination of elderly people. However, the association between lumbopelvic stiffness and fear of falling has not been studied. OBJECTIVES Osteopathic manipulative treatment/medicine (OMT/OMM), targeted to improve the stiffness of the pelvic girdle, may improve the prognosis of patients afraid of falling and slow down their loss of autonomy. METHODS We performed a prospective cohort study enrolling hospitalized patients and nursing home residents over 75 years of age. Patients able to walk and without significant cognitive impairment completed the International Fall Efficacy Scale (FES-I) questionnaire to assess their intensity of fear of falling. The modified Schober test and hip goniometry (flexion and extension) were measured and compared to the FES-I score. RESULTS A total of 100 patients were included. A high fear of falling (FES-I≥28) was associated with female sex (31 [79.5 %] vs. 29 [47.5 %]; p=0.002) and with a reduction in the amplitudes tested by the Schober test (2 [1.5-3] vs. 3 [2-4]; p=0.002), the hip extension goniometry (7 [4-10] vs. 10 [7-15]; p<0.001) and the hip flexion goniometry (70 [60-77] vs. 82 [71-90]; p<0.001). The association between FES-I score and each anthropometric variable was strongly linear (p<0.001 for all), especially with hip flexion goniometry (R2=30 %). CONCLUSIONS Lumbopelvic stiffness, especially in hip flexion, is strongly associated with a high fear of falling in patients over 75 years of age. When combined with other movement-based therapies, OMM targeted to improve the stiffness of the pelvic girdle may improve the prognosis of patients afraid of falling and slow down their loss of autonomy.
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Affiliation(s)
- Chloe Laizeau
- 56194 Groupe Hospitalier Sud Ile-de-France , Hôpital de Melun-Sénart, Melun, France
| | - Sebastien Jochmans
- 56194 Intensive Care Unit and Clinical Research Unit, Groupe Hospitalier Sud Ile-de-France , Hôpital de Melun-Sénart, Melun, France
| | - Sylvie Aufaure
- Geriatric Acute Care Department, 56194 Groupe Hospitalier Sud Ile-de-France , Hôpital de Melun-Sénart, Melun, France
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Liu Z, Xia Z, Kuang Y, Liu B. Older people's experiences of hospitalization for surgical intervention for hip fracture: A systematic review. Int J Orthop Trauma Nurs 2024; 54:101096. [PMID: 38599149 DOI: 10.1016/j.ijotn.2024.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Hip fracture always requires hospitalization with high cost, which cause the complicated experiences and feelings. OBJECTIVE To inform pre- and in-hospital communication practices between healthcare professionals and patients through a systematic review and qualitative research that synthesizes the experiences and feelings of older patients with hip fracture during the perioperative period. METHODS We searched the Cochrane Library, PubMed, Web of Science, CINAHL, and three Chinese databases for relevant studies. Qualitative studies were included if they were related to the experiences and needs of hospitalization of older patients with hip fracture. Study quality was evaluated using the 2016 Joanna Briggs Institute quality evaluation criteria for qualitative research, and the results were consolidated using an thematic synthesis approach. RESULTS Sixteen studies were included in our meta-synthesis. We extracted 58 clear research topics. Eight new categories were formed after induction and integration, which were finally merged into three integrated results. Integration result 1: Patients suffered a large amount of physical and psychological trauma. Integration result 2: A balance of proper protection and independence for patients is required. Integration result 3: Adequate pre-discharge preparation is required. CONCLUSIONS Our review suggests that healthcare professionals should reduce pain catastrophizing and the fear of falling after surgery among older people with hip fracture. Furthermore, adequate pre-discharge preparation should be made jointly with patients. Meeting patients' diverse needs by various methods will promote active and healthy aging.
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Affiliation(s)
- Zexuan Liu
- Department of Orthopaedic Trauma, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou City, Guangdong Province, China.
| | - Zhenlan Xia
- Department of Orthopaedic Trauma, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou City, Guangdong Province, China.
| | - Yuanfang Kuang
- Department of Nursing, Guangzhou Medical University,Guangzhou, China
| | - Beibei Liu
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Cedeno-Veloz BA, Casadamon-Munarriz I, Rodríguez-García A, Lozano-Vicario L, Zambom-Ferraresi F, Gonzalo-Lázaro M, Hidalgo-Ovejero ÁM, Izquierdo M, Martínez-Velilla N. Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial. J Clin Med 2023; 13:97. [PMID: 38202104 PMCID: PMC10779784 DOI: 10.3390/jcm13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear. METHODS This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery. DISCUSSION The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study's findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups.
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Affiliation(s)
- Bernardo Abel Cedeno-Veloz
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
| | - Irache Casadamon-Munarriz
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Alba Rodríguez-García
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Lucia Lozano-Vicario
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Gonzalo-Lázaro
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Ángel María Hidalgo-Ovejero
- Department of Orthopaedics Clinics and Traumatology, University Hospital of Navarre (HUN), 31008 Pamplona, Navarra, Spain;
| | - Mikel Izquierdo
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
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Fernandes JB, Domingos J, Família C, Santos C, Santana D, Gregório F, Costa I, Afonso J, Matos L, Marques S, Santos T, Fernandes S, Santos I, Sousa N, Ramos C, Godinho C. Landing wise program: feasibility study protocol for Parkinson's disease. Front Med (Lausanne) 2023; 10:1247660. [PMID: 37915322 PMCID: PMC10616464 DOI: 10.3389/fmed.2023.1247660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023] Open
Abstract
Regardless of the benefits of fall prevention programs, people with Parkinson's disease (PD) will still fall. Therefore, it is crucial to explore novel therapeutic approaches that are well-accepted and effective for addressing fall risk and the fear of falls among this population. The present study aims to assess the feasibility of the Landing Wise program as a therapeutic intervention for reducing the fear of falling in people with PD. A mixed-methods study will be conducted using convenience sampling to recruit 20 people with PD with a moderate concern of falling from a Parkinson's Patients Association. In addition to usual care, participants will attend 2 days per week, 90 min group sessions for 8 weeks. The intervention combines group cognitive behavioral intervention with the training of safe landing strategies. Feasibility will be assessed by six key domains (recruitment strategy and rates, enrollment, retention, acceptability, reasons for decline/withdrawal, and adverse events). Quantitative data will be analyzed using descriptive statistics to characterize the sample, followed by inferential statistics to evaluate differences in the Short Falls Efficacy Scale-International Scale, Movement Disorder Society Unified Parkinson's Disease Rating Scale, Timed Up Go, 6-Minutes Walking Distance, and fall frequency and severity scores between baseline and final assessment. Qualitative data will be analyzed using an inductive thematic analysis process. There is a growing interest in developing new effective therapeutic approaches for people with PD. If proven program feasibility, this study precedes a randomized controlled trial to establish the effectiveness of the Landing Wise program.
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Affiliation(s)
- Júlio Belo Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Josefa Domingos
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
| | - Carlos Família
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Molecular Pathology and Forensic Biochemistry Laboratory, Caparica, Portugal
| | - Cátia Santos
- Department of Nursing, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Diana Santana
- Department of Nursing, Hospital Garcia de Orta EPE (HGO), Almada, Portugal
| | | | - Inês Costa
- Department of Nursing, Hospital Garcia de Orta EPE (HGO), Almada, Portugal
| | - Joana Afonso
- Careceiver and NOVA Medical School (MS) & NOVA School of Business and Economics (SBE), Lisbon, Portugal
| | - Lúcia Matos
- Department of Nursing, Hospital Garcia de Orta EPE (HGO), Almada, Portugal
| | - Solange Marques
- Department of Nursing, Hospital Garcia de Orta EPE (HGO), Almada, Portugal
| | - Tânia Santos
- Department of Nursing, Hospital Garcia de Orta EPE (HGO), Almada, Portugal
| | - Sónia Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Isabel Santos
- ARS LVT, ACES Arrábida, UCC Palmela, Palmela, Portugal
| | - Natacha Sousa
- ARS LVT, ACES Lisboa Norte, UCC Integrar na Saúde - ECCI Benfica, Lisbon, Portugal
| | - Catarina Ramos
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- LabPSI, Almada, Portugal
| | - Catarina Godinho
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
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Licina S, Kjeken I, Førland O, Langeland E, Tuntland H. Exploring Goals and Functional Changes in Reablement for People with Fractures and People with Dizziness and Balance Problems. J Multidiscip Healthc 2023; 16:2323-2337. [PMID: 37601327 PMCID: PMC10439777 DOI: 10.2147/jmdh.s417883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Background Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited. Aim To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals. Material and Methods The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired t-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation. Results Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups. Conclusion The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program. Significance Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement.
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Affiliation(s)
- Selma Licina
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ingvild Kjeken
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Oddvar Førland
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eva Langeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hanne Tuntland
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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9
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Scheffers-Barnhoorn MN, Haaksma ML, Achterberg WP, Niggebrugge AH, van der Sijp MP, van Haastregt JC, van Eijk M. Course of fear of falling after hip fracture: findings from a 12-month inception cohort. BMJ Open 2023; 13:e068625. [PMID: 36918243 PMCID: PMC10016251 DOI: 10.1136/bmjopen-2022-068625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES To examine the course of fear of falling (FoF) up to 1 year after hip fracture, including the effect of prefracture FoF on the course. DESIGN Observational cohort study with assessment of FoF at 6, 12 and 52 weeks after hip fracture. SETTING Haaglanden Medical Centre, the Netherlands. PARTICIPANTS 444 community-dwelling adults aged 70 years and older, admitted to hospital with a hip fracture. MAIN OUTCOME MEASURE Short Falls Efficacy Scale International (FES-I), with a cut-off score ≥11 to define elevated FoF levels. RESULTS Six weeks after hip fracture the study population-based mean FES-I was located around the cut-off value of 11, and levels decreased only marginally over time. One year after fracture almost one-third of the population had FoF (FES-I ≥11). Although the group with prefracture FoF (42.6%) had slightly elevated FES-I levels during the entire follow-up, the effect was not statistically significant. Patients with persistent FoF at 6 and 12 weeks after fracture (26.8%) had the highest FES-I levels, with a mean well above the cut-off value during the entire follow-up. For the majority of patients in this group, FoF is still present 1 year after fracture (84.9%). CONCLUSIONS In this study population, representing patients in relative good health condition that are able to attend the outpatient follow-up at 6 and 12 weeks, FoF as defined by an FES-I score ≥11 was common within the first year after hip fracture. Patients with persistent FoF at 12 weeks have the highest FES-I levels in the first year after fracture, and for most of these patients the FoF remains. For timely identification of patients who may benefit from intervention, we recommend structural assessment of FoF in the first 12 weeks after fracture.
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Affiliation(s)
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
| | | | - Max Pl van der Sijp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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10
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Stefanakis M, Sakellari V, Klenk J, Kampe K, Klimek M, Pfeiffer K, Becker C. Unlocking the black box of geriatric physiotherapy : Quantification of physical activity and walking parameters during inpatient geriatric rehabilitation therapy sessions. Z Gerontol Geriatr 2022; 55:637-643. [PMID: 36326865 DOI: 10.1007/s00391-022-02126-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Physiotherapy and occupational therapy are currently described using the duration of treatment (days or weeks), the frequency of therapy sessions (on a daily or 3-5 days per week basis) and considering the duration of a session (e.g., 30 or 45 min). The content is often poorly defined and the intensity is rarely reported. Using digital technology some of these shortcomings can be overcome. The cumulative parameters of walking and activity sessions, the duration of walking, the time spent in an upright or lying/sitting position and the number of steps can now be analyzed. In this study, we examined the parameters during non-treatment periods and therapy time in patients recovering from fragility fractures. METHODS The study is a secondary data analysis of a trial that examined the improvement of physical activity (PA) and self-efficacy of fragility fracture patients. Changes in mobility parameters were measured using the ActivPal3 sensor during the 1st and 3rd weeks of rehabilitation and 104 patients were analyzed (mean age 82.5 years). Parameters included the time during supervised treatment, the mean number of steps, cumulative time in an upright position and walking duration, the number of walking intervals of > 10 s and sit to stand transfers. RESULTS Patients received 3-4 therapy sessions adding up to 90-120 min per day. More than 50% of the daily walking activities were achieved in these sessions until discharge. With this amount of therapeutic input most parameters meaningfully improved from baseline to the second measurement. The number of steps increased by 30%, the mean time in an upright position increased by 26% and the mean time spent walking increased by 49%. CONCLUSION The sensor-derived measurements describe the amount of walking activity administered during the supervised therapy sessions. This could be used as a starting point for future trials to improve the outcomes or as a standard of process evaluation for clinical services.
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Affiliation(s)
- Marios Stefanakis
- Physiotherapy Department, University of West Attica, 12243, Egaleo, Athens, Greece.
| | - Vasiliki Sakellari
- Physiotherapy Department, University of West Attica, 12243, Egaleo, Athens, Greece
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Karin Kampe
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Matthias Klimek
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany. .,Unit Digitale Geriatrie, Universitätsklinikum Heidelberg, Bergheimerstr. 20, 69115, Heidelberg, Germany.
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11
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Taylor NF, Shields N, Thompson AL, O'Halloran PD, Harding KE, Dennett AM, Hau R, Peiris CL. A walking programme for adults living in the community after hip fracture: A feasibility randomized controlled trial. Clin Rehabil 2022; 37:47-59. [PMID: 36163694 DOI: 10.1177/02692155221128721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. DESIGN A randomized controlled trial with embedded qualitative analysis. SETTING Community. PARTICIPANTS Aged at least 60 years and living in the community after hip fracture. INTERVENTIONS In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking. MAIN OUTCOME MEASURES Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy. RESULTS Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2-13). There were no between-group differences in mobility, walking confidence or quality of life. CONCLUSION A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.
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Affiliation(s)
- Nicholas F Taylor
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia
| | - Anne L Thompson
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Paul D O'Halloran
- School of Public Health and Psychology, 2080La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Amy M Dennett
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Raphael Hau
- Department of Orthopaedics, Eastern Health, Box Hill, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia
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12
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Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2022; 9:CD001704. [PMID: 36070134 PMCID: PMC9451000 DOI: 10.1002/14651858.cd001704.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improving mobility outcomes after hip fracture is key to recovery. Possible strategies include gait training, exercise and muscle stimulation. This is an update of a Cochrane Review last published in 2011. OBJECTIVES To evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, trial registers and reference lists, to March 2021. SELECTION CRITERIA All randomised or quasi-randomised trials assessing mobility strategies after hip fracture surgery. Eligible strategies aimed to improve mobility and included care programmes, exercise (gait, balance and functional training, resistance/strength training, endurance, flexibility, three-dimensional (3D) exercise and general physical activity) or muscle stimulation. Intervention was compared with usual care (in-hospital) or with usual care, no intervention, sham exercise or social visit (post-hospital). DATA COLLECTION AND ANALYSIS Members of the review author team independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We used the assessment time point closest to four months for in-hospital studies, and the time point closest to the end of the intervention for post-hospital studies. Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects and return to living at pre-fracture residence. MAIN RESULTS We included 40 randomised controlled trials (RCTs) with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%). In-hospital setting, mobility strategy versus control Eighteen trials (1433 participants) compared mobility strategies with control (usual care) in hospitals. Overall, such strategies may lead to a moderate, clinically-meaningful increase in mobility (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.10 to 0.96; 7 studies, 507 participants; low-certainty evidence) and a small, clinically meaningful improvement in walking speed (CI crosses zero so does not rule out a lack of effect (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, 360 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to short-term (risk ratio (RR) 1.06, 95% CI 0.48 to 2.30; 6 studies, 489 participants; low-certainty evidence) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, 133 participants; low-certainty evidence), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, 322 participants; low-certainty evidence), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, 240 participants; low-certainty evidence). We are uncertain whether mobility strategies improve functioning or health-related quality of life as the certainty of evidence was very low. Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, 463 participants; moderate-certainty evidence). There was little or no difference in effects on mobility for resistance training. No studies of other types of exercise or electrical stimulation reported mobility outcomes. Post-hospital setting, mobility strategy versus control Twenty-two trials (2626 participants) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small, clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, 761 participants; high-certainty evidence) and a small, clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, 1067 participants; high-certainty evidence). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, 936 participants; high-certainty evidence), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, 785 participants; moderate-certainty evidence). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, 737 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, 588 participants; low-certainty evidence) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, 206 participants; low-certainty evidence). Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, 621 participants; high-certainty evidence), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, 198 participants; low-certainty evidence). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, 104 participants; moderate-certainty evidence). We are uncertain of the effect of aerobic training on mobility (very low-certainty evidence). No studies of other types of exercise or electrical stimulation reported mobility outcomes. AUTHORS' CONCLUSIONS Interventions targeting improvement in mobility after hip fracture may cause clinically meaningful improvement in mobility and walking speed in hospital and post-hospital settings, compared with conventional care. Interventions that include training of gait, balance and functional tasks are particularly effective. There was little or no between-group difference in the number of adverse events reported. Future trials should include long-term follow-up and economic outcomes, determine the relative impact of different types of exercise and establish effectiveness in emerging economies.
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Affiliation(s)
- Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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13
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Naseri C, Haines TP, Morris ME, McPhail SM, Etherton-Beer C, Shorr R, Flicker L, Waldron N, Bulsara M, Hill AM. Factors Affecting Engagement of Older Adults in Exercise Following Hospitalization. J Geriatr Phys Ther 2022; 45:197-206. [PMID: 35905031 DOI: 10.1519/jpt.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge. METHODS This study was a secondary analysis of data collected as part of a randomized controlled trial. Participants were 60 years and older, discharged from 3 rehabilitation hospitals in Australia, and followed for 6 months after discharge. The primary outcome was level of engagement in exercise after discharge, measured using setting, type, frequency, and time. A secondary outcome was self-efficacy for exercise at 6-month follow-up. Data were gathered at baseline in hospital and at 6 months after discharge by telephone using structured surveys. Associations between exercise and participant characteristics were evaluated using logistic regression models. RESULTS AND DISCUSSION Participants' (n = 292) mean age was 78 (SD 8) years and 63% were female. There were 146 (50%) who exercised after hospitalization for a median (interquartile range) time of 60 (60-75) minutes per week. Characteristics that were significantly associated with post-discharge engagement in exercise were having higher levels of functional ability at discharge (adjusted odds ratio [AOR] 1.2, 95% CI 1.0, 1.4), living with a partner (AOR 2.9, 95% CI 1.7, 4.9), and engagement in exercise prior to hospital admission (AOR 1.7, 95% CI 1.0, 2.8). The mean self-efficacy for exercise score at 6 months post-discharge was 58.5/90 (SD 24.5). Characteristics that were significantly predictive of a higher mean self-efficacy score at 6 months after hospitalization were having a college or university education (adjusted β-coefficient [Adj β] 11.5, 95% CI 3.8, 19.0), exercise prior to hospital admission (Adj β 12.3, 95% CI 5.1, 19.5), living with a partner at discharge (Adj β 14.5, 95% CI 7.1, 21.9), and higher functional ability at discharge (Adj β 4.0, 95% CI 1.9, 6.1). CONCLUSION Older adults have low levels of engagement in exercise that might impact their recovery after hospitalization. During exercise prescription, clinicians should prioritize older adults who live alone, who have lower functional ability, and no previous habit of exercising.
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Affiliation(s)
- Chiara Naseri
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.,WA Centre for Health and Ageing, University of Western Australia, Perth, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
| | - Meg E Morris
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Australia.,College of Healthcare Sciences, James Cook University, Douglas, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, University of Western Australia, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida.,College of Medicine, University of Florida, Gainesville
| | - Leon Flicker
- WA Centre for Health and Ageing, University of Western Australia, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Nicolas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Mount Nasura, and Department of Health Western Australia, Perth, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Anne-Marie Hill
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.,WA Centre for Health and Ageing, University of Western Australia, Perth, Australia
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14
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Geohagen O, Hamer L, Lowton A, Guerra S, Milton-Cole R, Ellery P, Martin FC, Lamb SE, Sackley C, Sheehan KJ. The effectiveness of rehabilitation interventions including outdoor mobility on older adults' physical activity, endurance, outdoor mobility and falls-related self-efficacy: systematic review and meta-analysis. Age Ageing 2022; 51:6612691. [PMID: 35737601 PMCID: PMC9220027 DOI: 10.1093/ageing/afac120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the effectiveness of community-based rehabilitation interventions which incorporate outdoor mobility on physical activity, endurance, outdoor mobility and falls-related self-efficacy in older adults. Design MEDLINE, Embase, CINAHL, PEDro and OpenGrey were searched systematically from inception to June 2021 for randomised controlled trials (RCTs) of community-based rehabilitation incorporating outdoor mobility on physical activity, endurance, outdoor mobility and/or falls-related self-efficacy in older adults. Duplicate screening, selection, extraction and appraisal were completed. Results were reported descriptively and with random-effects meta-analyses stratified by population (proactive [community-dwelling], reactive [illness/injury]). Results A total of 29 RCTs with 7,076 participants were identified (66% high bias for at least one domain). The outdoor mobility component was predominantly a walking programme with behaviour change. Rehabilitation for reactive populations increased physical activity (seven RCTs, 587 participants. Hedge’s g 1.32, 95% CI: 0.31, 2.32), endurance (four RCTs, 392 participants. Hedges g 0.24; 95% CI: 0.04, 0.44) and outdoor mobility (two RCTs with 663 participants. Go out as much as wanted, likelihood of a journey) at intervention end versus usual care. Where reported, effects were preserved at follow-up. One RCT indicated a benefit of rehabilitation for proactive populations on moderate-to-vigorous activity and outdoor mobility. No effect was noted for falls-related self-efficacy, or other outcomes following rehabilitation for proactive populations. Conclusion Reactive rehabilitation for older adults may include walking programmes with behaviour change techniques. Future research should address the potential benefit of a walking programme for proactive populations and address mobility-related anxiety as a barrier to outdoor mobility for both proactive and reactive populations.
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Affiliation(s)
- Olyvia Geohagen
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Lydia Hamer
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Alexandra Lowton
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | | | - Finbarr C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Sallie E Lamb
- Institute of Health Research, University of Exeter, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
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15
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Leland NE, Lekovitch C, Martínez J, Rouch S, Harding P, Wong C. Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults. J Appl Gerontol 2022; 41:2187-2196. [PMID: 35618304 DOI: 10.1177/07334648221104375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.
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Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Cara Lekovitch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenny Martínez
- Department of Occupational Therapy, 6559Jefferson College of Rehabilitation Sciences, Philadelphia, PA, USA
| | - Stephanie Rouch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Harding
- Chan Division of Occupational Science and Occupational Therapy, 5116University of Southern California, Los Angeles, CA, USA
| | - Carin Wong
- Department of Sociology, 14669California State University Los Angeles, Los Angeles, CA, USA
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16
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Taylor NF, Harding KE, Dennett AM, Febrey S, Warmoth K, Hall AJ, Prendergast LA, Goodwin VA. Behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression. Age Ageing 2022; 51:6326506. [PMID: 34304267 PMCID: PMC8753032 DOI: 10.1093/ageing/afab154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. OBJECTIVE This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. METHODS Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. RESULTS Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14-0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05-0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11-0.60) were independently associated with increased physical activity. CONCLUSIONS Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital.
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Affiliation(s)
- Nicholas F Taylor
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Box Hill, Victoria 3128, Australia
| | - Katherine E Harding
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Box Hill, Victoria 3128, Australia
| | - Amy M Dennett
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
- Allied Health Clinical Research Office, Box Hill, Victoria 3128, Australia
| | - Samantha Febrey
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Krystal Warmoth
- NIHR ARC East of England, University of Hertfordshire, Centre for Research In Public Health And Community Care (CRIPACC), Hatfield AL10 9AB, UK
| | - Abi J Hall
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Luke A Prendergast
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Victoria A Goodwin
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
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Dolan H, Slebodnik M, Taylor-Piliae R. Older adults' perceptions of their fall risk in the hospital: An integrative review. J Clin Nurs 2021; 31:2418-2436. [PMID: 34786777 DOI: 10.1111/jocn.16125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/18/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. BACKGROUND Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. DESIGN An integrative review. METHODS An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. RESULTS Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. CONCLUSIONS Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. RELEVANCE TO CLINICAL PRACTICE Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.
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Affiliation(s)
- Hanne Dolan
- College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Maribeth Slebodnik
- Arizona Health Sciences Library and College of Nursing, The University of Arizona, Tucson, Arizona, USA
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18
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Chau JPC, Lo SHS, Choi KC, Butt L, Zhao J, Thompson DR. Participation self-efficacy plays a mediation role in the association between mobility and social participation among stroke survivors. Heart Lung 2021; 50:857-862. [PMID: 34333221 DOI: 10.1016/j.hrtlng.2021.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mobility is a major determinant of social participation after stroke and the relationship between the two may be mediated by participation self-efficacy. OBJECTIVE To investigate the hypothesis that participation self-efficacy mediates the association between mobility and social participation among stroke survivors. METHODS A secondary data analysis of a cross-sectional study aiming to validate the Chinese version of the Participation Strategies Self-Efficacy Scale was conducted. Three hundred and thirty-six stroke survivors were recruited. With mobility as the predictor variable and social participation as the outcome, path analysis was utilized to assess the mediating effect of participation self-efficacy on the association between the two factors. RESULTS Mobility was significantly associated with social participation (B=2.773, p<0.001) and participation self-efficacy (B=6.060, p<0.001). After adjusting for mobility, participation self-efficacy was significantly associated with social participation. The association between mobility and social participation was mediated by participation self-efficacy. CONCLUSIONS When aiming to improve stroke survivor community reintegration, interventions targeted at boosting participation self-efficacy must be considered given its beneficial mediatory effect on mobility and social participation.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Laveeza Butt
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Jie Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom.
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19
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Kampe K, Pfeiffer K, Lindemann U, Schoene D, Taraldsen K, Rapp K, Becker C, Klenk J. Change of physical activity parameters of hip and pelvic fracture patients during inpatient rehabilitation and after discharge: analysis of global and in-depth parameters. Eur Rev Aging Phys Act 2021; 18:9. [PMID: 34118878 PMCID: PMC8199557 DOI: 10.1186/s11556-021-00261-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps. These traditional parameters mix different domains of PA, such as physical capacity (PC), behaviour and living environment. We examined the change of global cumulative PA measures during rehabilitation and after discharge in patients with hip or pelvic fracture and whether more ‘in-depth’ PA parameters, such as walking interval length, variability of interval length and sit-to-stand transitions and their changes during rehabilitation and 3 months after discharge might better reflect the above mentioned three clinically relevant domains of PA. Methods This study is a secondary data analysis of a randomised controlled trial to improve PA and fall-related self-efficacy in hip or pelvic fracture patients (≥60 years) with concerns about falling. Changes of accelerometer-measured global cumulative and in-depth PA parameters (activPAL3) were analysed in an observational design before and after discharge combining both groups. For comparison, the same analyses were applied to the traditional PC measures gait speed and 5-chair-rise. Results Seventy-five percent of the 111 study participants were female (mean age: 82.5 (SD = 6.76) years. Daily walking duration, upright time and number of steps as aspects of global PA increased during inpatient rehabilitation as well as afterwards. The in-depth PA parameters showed differing patterns. While the total number of walking bouts increased similarly, the number of longer walking bouts decreased by 50% after discharge. This pattern was also seen for the average walking interval length, which increased by 2.34 s (95% confidence interval (CI): 0.68; 4.00) during inpatient rehabilitation and decreased afterwards below baseline level (− 4.19 s (95% CI: − 5.56; − 2.82)). The traditional PC measures showed similar patterns to the in-depth PA parameters with improvements during rehabilitation, but not at home. Conclusion Our findings suggest that the in-depth PA parameters add further information to the global cumulative PA parameters. Whereas global cumulative PA parameters improved significantly during inpatient rehabilitation and after discharge, in-depth PA parameters as well as PC did not continuously improve at home. In contrast to global cumulative PA parameters the in-depth parameters seem to reflect contextual factors such as the build environment and aspects of PC, which are traditionally assessed by clinical PC measures. These in combination with digital mobility measures can help clinicians to assess the health status of fragility fracture patients, individually tailor therapy measures and monitor the rehabilitation process.
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Affiliation(s)
- Karin Kampe
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Ulrich Lindemann
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Henkestr. 91, 91052, Erlangen, Germany
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491, Trondheim, Norway
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany. .,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany. .,IB University for Health and Social Sciences, Study Center Stuttgart, Paulinenstraße 45, 70178, Stuttgart, Germany.
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20
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Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, van Balen R, Kempen GIJM, Achterberg WP, van Haastregt JCM. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr 2021; 21:224. [PMID: 33794804 PMCID: PMC8017759 DOI: 10.1186/s12877-021-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION Netherlands Trial Register: NTR5695 (7 March 2016).
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Affiliation(s)
- Maaike N Scheffers-Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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21
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Dautel A, Gross M, Abel B, Pomiersky R, Eckert T, Hauer K, Schäufele M, Büchele G, Becker C, Pfeiffer K. Psychometric properties of the German version of the Fear of Falling Questionnaire-revised (FFQ-R) in a sample of older adults after hip or pelvic fracture. Aging Clin Exp Res 2021; 33:329-337. [PMID: 32705586 DOI: 10.1007/s40520-020-01657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying patients with maladaptive fear of falling (FOF) is important in the rehabilitation phase after serious fall. The 6-item Fear of Falling Questionnaire-revised (FFQ-R) was seen as promising measurement instrument as it evaluates FOF in a broader way than the one-item-question and independent of physical activities. AIM The purpose of the analysis was to evaluate the psychometric properties of the translated German FFQ-R. METHODS Back-translation method was applied. Confirmatory factor analysis (CFA) with diagonally weighted least square estimation was used to verify the two-factor structure. Data were collected during inpatient rehabilitation from hip and pelvic fracture patients [age 84.3 ± 6.2, Mini-Mental State Examination (MMSE) scores > 23] participating in an RCT (N = 112) and a cross-sectional survey (N = 40). RESULTS Internal consistency was 0.78 (Cronbach´s alpha). No floor or ceiling effects were found. Discriminatory power on item level was moderate to good (r = 0.43-0.65). CFA revealed a good model fit and confirmed the two-factor structure. The German FFQ-R was moderately correlated (r = 0.51) with the Short Falls Efficacy Scale-International (Short FES-I) used as a proxy measure for FOF. Missing rates up to 9% for specific items were because some individuals, independent of cognitive level or age, had problems to rate items with conditional statements on possible negative consequences of a fall. CONCLUSIONS Results demonstrated moderate to good psychometric properties similar to the original English version in a comparable sample of fracture patients.
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Sheehan KJ, Fitzgerald L, Lambe K, Martin FC, Lamb SE, Sackley C. 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. Arch Osteoporos 2021; 16:99. [PMID: 34148132 PMCID: PMC8214580 DOI: 10.1007/s11657-021-00963-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/23/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED There is limited evidence from 11 randomised controlled trials on the effect of rehabilitation interventions which incorporate outdoor mobility on ambulatory ability and/or self-efficacy after hip fracture. Outdoor mobility should be central (not peripheral) to future intervention studies targeting improvements in ambulatory ability. PURPOSE Determine the extent to which outdoor mobility is incorporated into rehabilitation interventions after hip fracture. Synthesise the evidence for the effectiveness of these interventions on ambulatory ability and falls-related self-efficacy. METHODS Systematic search of MEDLINE, Embase, PsychInfo, CINAHL, PEDro and OpenGrey for published and unpublished randomised controlled trials (RCTs) of community-based rehabilitation interventions incorporating outdoor mobility after hip fracture from database inception to January 2021. Exclusion of protocols, pilot/feasibility studies, secondary analyses of RCTs, nonrandomised and non-English language studies. Duplicate screening for eligibility, risk of bias, and data extraction sample. Random effects meta-analysis. Statistical heterogeneity with inconsistency-value (I2). RESULTS RCTs (n = 11) provided limited detail on target or achieved outdoor mobility intervention components. There was conflicting evidence from 2 RCTs for the effect on outdoor walking ability at 1-3 months (risk difference 0.19; 95% confidence intervals (CI): 0.21, 0.58; I2 = 92%), no effect on walking endurance at intervention end (standardised mean difference 0.05; 95% CI: - 0.26, 0.35; I2 = 36%); and suggestive (CI crosses null) of a small effect on self-efficacy at 1-3 months (standardised mean difference 0.25; 95% CI: - 0.29, 0.78; I2 = 87%) compared with routine care/sham intervention. CONCLUSION It was not possible to attribute any benefit observed to an outdoor mobility intervention component due to poor reporting of target or achieved outdoor mobility and/or quality of the underlying evidence. Given the low proportion of patients recovering outdoor mobility after hip fracture, future research on interventions with outdoor mobility as a central component is warranted. TRIAL REGISTRATION PROSPERO registration: CRD42021236541.
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Affiliation(s)
- Katie J. Sheehan
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK
| | - Laura Fitzgerald
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK
| | - Kate Lambe
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK
| | - Finbarr C. Martin
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK
| | - Sallie E. Lamb
- grid.8391.30000 0004 1936 8024Institute of Health Research, University of Exeter, Devon, UK
| | - Catherine Sackley
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, London, UK
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