Effects of the FIT-HIP Intervention for Fear of Falling After Hip Fracture: A Cluster-Randomized Controlled Trial in Geriatric Rehabilitation

Abstract

Objectives: Fear of falling (FoF) is common after hip fracture and can impede functional recovery because of activity restriction. The Fear of falling InTervention in HIP fracture geriatric rehabilitation (FIT-HIP intervention) was designed to target FoF and consequently to improve mobility. The aim of this study was to evaluate the effect of the FIT-HIP intervention in patients with FoF in geriatric rehabilitation (GR) after hip fracture. Design, setting, and participants: This cluster-randomized controlled trial was performed in 11 post-acute GR units in the Netherlands (2016)(2017). Six clusters were assigned to the intervention group, 5 to the usual care group. We included 78 patients with hip fracture and FoF (aged !65 years; 39 per group). Intervention(s): The FIT-HIP intervention is a multicomponent cognitive behavioral intervention conducted by physiotherapists, embedded in usual care in GR. The FIT-HIP intervention was compared to usual care in GR. Measurements: FoF was assessed with the Falls Efficacy ScaleeInternational (FES-I) and mobility, with the Performance Oriented Mobility Assessment (POMA). Data were collected at baseline, discharge, and 3 and 6 months postdischarge from GR. Primary endpoints were change scores at discharge. Linear mixed models were used to evaluate the treatment effect. Results: No significant between-group differences were observed for primary outcome measures. With the usual care group as reference, the FES-I estimated difference between mean change scores was 3.3 [95% confidence interval (CI) À1.0, 7.5, P ¼ .13] at discharge from GR; À4.1 (95% CI e11.8, 3.6, P ¼ .29) after 3 months; and À2.8 (95% CI e10.0, 4.4, P ¼ .44) after 6 months. POMA estimated difference was À0.3 (95% CI e6.5, 5.8, P ¼ .90). Conclusion/Implications: The FIT-HIP intervention was not effective in reducing FoF. Possibly FoF (shortly) after hip fracture can to some extent be appropriate. This may imply the study was not able to accurately identify and accordingly treat FoF that is maladaptive (reflective of disproportionate anxiety).

Coping strategies of older adults with a recent hip fracture within inpatient geriatric rehabilitation

“…All participants had FoF, which may have biased the findings regarding symptoms of anxiety and depression. On the other hand, FoF has been reported in as much as 60% of the older patients with hip fracture (Visschedijk et al, 2013), and the level of anxiety reported in the study population was low (Scheffers-Barnhoorn et al, 2019). Also, FoF is not limited to patients with hip fracture; prevalence rates in the general geriatric population and in other geriatric rehabilitation patients are high too (Scheffer, Schuurmans, van Dijk, van der Hooft, & de Rooij, 2008;Visschedijk, Caljouw, Bakkers, van Balen, & Achterberg, 2015).…”

Physical Therapy Management of Older Adults With Hip Fracture

“…Scheffers-Barnhoorn et al 236 conducted a cluster RCT in inpatient rehabilitation units in the Netherlands to assess the impact of a multicomponent cognitive behavioral intervention, integrated by physical therapists into treatment after surgery for hip fracture, on falls self-efficacy. No differences were found between groups in physical performance, falls efficacy, or self-reported activity restriction.…”

Prognostic Factors for Short-term Recovery of Independence in a Multistate Model for Patients With a Hip Fracture

“…Patients receive on average 3 to 6 sessions of physiotherapy per week, though intensity varies depending on the patients' physical endurance and formalized agreements employed by the rehabilitation units. 27 Additional treatment aspects during geriatric rehabilitation concern general medical care, fall prevention, osteoporosis, nutrition, and fear or depression.…”