Testing the effectiveness of the exercise plus program in older women post-hip fracture

Abstract

The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only, exercise only, and the exercise plus groups all increased exercise.

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

“…10,73,91 This has been successfully shown in the rehabilitation of patients with stroke 247 and other conditions. 61,62,214 This review identified that mutual aid and social support, 246 combined with the development of practical skills through supervised practice and exercise, 243,248 have the potential to improve quality of life and reduce the rates of rehospitalisation and long-term institutionalisation.…”

“…116 Self-efficacy, which is an important tenet of social cognitive theory, is the belief in one's ability to successfully complete tasks, reach goals and face challenges. 69,71,73 This influences the activities that a person engages in and his or her perseverance in the face of difficulties: 206 I was just determined to do them [exercises], and I was determined to walk. I was determined to do everything for myself that I could.…”

“…Female patient 90 A rehabilitation programme 73 that used written materials as reminders to continue exercising safely was shown to be acceptable to participants and kept them motivated and reassured about the safety and effectiveness of the programme, with the majority of patients commending its simplicity and ease of use. 72 Similarly, visual cues in the booklets helped patients to remember to exercise:…”

“…l coaching may have a minimal effect if started immediately after surgery in hospital 91 but has been shown to enhance patients' self-efficacy, skills and mastery to perform exercises independently if provided in the community soon after discharge 36,69,72,73,244,245,249 l occupational therapy and interventions for fear of falling in the acute hospital have a minimal effect 99,245 but appear to be effective when provided at patients' usual place of residence, 244,245,250 probably because patients start ambulating either independently or with help and can appreciate that l supervised physical training and earlier mobilisation in rehabilitation programmes during the acute hospital stay, 36 and strength and progressive resistance training later in the programmes, either during or after discharge, appear to improve outcomes, 25,36,57,251 as earlier commencement of intensive physical therapy may act as a hindrance and there is a danger of patients becoming disengaged or dropping out of programmes 9 because of the challenging nature of the tasks l falls prevention programme training combined with supervised exercise to improve self-efficacy and regain confidence, 36 but only after patients have restarted walking. 5,9 Similarly, no single pathway provides the answers to all patient issues because of the complexity of comorbidities with which hip fracture patients can present.…”

“…73 The Exercise Plus Program combined an exercise programme with a motivational intervention. In the UK NHS there are too few clinicians available to enable a psychological intervention to be delivered for the rehabilitation of a physical illness.…”