Management of fear of falling after hip fracture

Fear of falling (FoF) after hip fracture is highly prevalent, and has been associated with diminished functional recovery. A treatment program for FoF after hip fracture was developed, for the inpatient geriatric rehabilitation setting (the FIT-HIP intervention, a multi-component cognitive behavioral intervention).The first studies of this thesis evaluated the effects and feasibility of the FIT-HIP intervention. Also, coping strategies used by patients with FoF were explored. The final study in this thesis evaluated the long-term course of FoF after fracture.The FIT-HIP intervention was not effective to reduce FoF and improve functional recovery after hip fracture. The (early) timing of the intervention, and a limited level of FoF may have contributed to the lack of treatment effect. Possibly not all FoF that is present very shortly after hip fracture (ZonMw, research grant number 839120004; SBOH (employer of elderly care medicine trainees)LUMC / Geneeskund

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

ObjectivesCoping strategies may play an important role as facilitator or barrier for functional recovery after hip fracture. This study explored 1] active and passive coping strategies in hip fracture patients within inpatient geriatric rehabilitation (GR) 2] the association of these coping strategies with depression, anxiety, pain and health-related quality of life (HRQoL)MethodSecondary data analysis (FIT-HIP trial). Participants were patients with hip fracture, aged 65+ years, admitted to post-acute GR units. Coping was assessed using the 'Active Tackling' and 'Passive Reacting' subscale of Utrecht Coping List (UCL). Depression, anxiety, pain and HRQoL was assessed using GDS-8, HADS-A, NPRS and EQ5D-VAS. Based on UCL norm tables - for both subscales - we dichotomized the group into (extremely) high use of this coping strategy i.e. 'predominantly active coping' (PAC), and 'predominantly passive coping' (PPC); versus their corresponding 'residual groups', i.e. the remaining participants.Results72 participants were included. Participants mostly used active coping (PAC: 33.3%), however those engaging in passive coping (23.6%) had significantly more depression and anxiety symptoms (GDS-8 >= 3: 31.1% respectively 9.1%, p = 0.040; HADS-A >= 7: 58.8% vs 10.9%; p = 0.00).ConclusionActive tackling and passive reacting coping strategies are used by up to one-third of patients with recent hip fracture. Passive coping was associated with more symptoms of depression and anxiety, which in turn may influence rehabilitation negatively. Screening of (passive) coping strategies could contribute to prompt identification of hip fracture patients at risk for negative health outcomes.Public Health and primary careGeriatrics in primary car

Evidence based medicine in de ouderengeneeskundige praktijk en opleiding

Evidence based medicine in de ouderengeneeskundige praktijk is een uitdaging. Met beperkt wetenschappelijk bewijs specifiek voor de doelgroep vraagt het van de specialist ouderengeneeskunde de nodige creativiteit. Hoe ga je hier mee om in de praktijk? Wat betekent dat voor de competenties die de specialist ouderengeneeskunde nodig heeft? En hoe kan je deze het beste ontwikkelen in de opleiding

Evidence based medicine in de ouderengeneeskundige praktijk en opleiding

Evidence based medicine in de ouderengeneeskundige praktijk is een uitdaging. Met beperkt wetenschappelijk bewijs specifiek voor de doelgroep vraagt het van de specialist ouderengeneeskunde de nodige creativiteit. Hoe ga je hier mee om in de praktijk? Wat betekent dat voor de competenties die de specialist ouderengeneeskunde nodig heeft? En hoe kan je deze het beste ontwikkelen in de opleiding

Evidence based medicine in de ouderengeneeskundige praktijk en opleiding

Evidence based medicine in de ouderengeneeskundige praktijk is een uitdaging. Met beperkt wetenschappelijk bewijs specifiek voor de doelgroep vraagt het van de specialist ouderengeneeskunde de nodige creativiteit. Hoe ga je hier mee om in de praktijk? Wat betekent dat voor de competenties die de specialist ouderengeneeskunde nodig heeft? En hoe kan je deze het beste ontwikkelen in de opleiding

Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention

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).Keywords: Cognitive behavioral intervention; Fear of falling; Feasibility; Geriatric rehabilitation; Hip fracture; Process evaluation.Geriatrics in primary carePublic Health and primary carePrevention, Population and Disease management (PrePoD

Course of fear of falling after hip fracture: findings from a 12-month inception cohort

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

A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial

Analysis and support of clinical decision makin

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

Development and application of statistical models for medical scientific researc