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

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

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

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

BACKGROUND: Hip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of falling and associated activity restriction and thereby improves physical functioning. METHODS/DESIGN: This multicentre cluster randomised controlled trial will be conducted among older patients with hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive behavioural therapy, including guided exposure to feared activities (that are avoided by the participants). Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at 3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention will be evaluated. Primary outcome measures are fear of falling and mobility. DISCUSSION: Targeted treatment of fear of falling may improve recovery and physical and social functioning after hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the intervention is feasible. TRIAL REGISTRATION: Netherlands Trial Register: NTR 5695