To determine the effects, feasibility and costs of a multi-component cognitive behavioural intervention for reducing fear of falling and associated activity restriction in hip fracture patients admitted for geriatric rehabilitation.
ID
Source
Brief title
Condition
- Other condition
- Anxiety disorders and symptoms
Synonym
Health condition
orthopedisch (heupfractuur) en als toevoeging bij psychische stoornis: verandering in lichamelijke activiteit
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Effect evaluation: Reduction in the fear of falling, measured with the Falls
Efficacy Scale International (FES-I). Improvement in mobility measured by the
Tinetti Performance Oriented Mobility Assessment (POMA).
Process evaluation: Within the framework of the process evaluation, fidelity;
completeness; exposure; satisfaction; reach; recruitment and context will be
evaluated by quantitative and qualitative analysis.
Economic evaluation: This consists of a cost-effectiveness analysis. The health
care costs consist of intervention costs and general health care costs such as
costs for the rehabilitation, hospital administrations, use of physiotherapy
and home care.
Secondary outcome
- Functional status (activities of daily living; measured with the Barthel
Index and Functional Ambulation Categories),
- Participation (Utrechtse Schaal voor de Evaluatie van Revalidatie-
Participatie- subscale/ question 2)
- Quality of life (EQ5D)
- Fall frequency (measured by self registration fall calendars)
- Discharge destination
Background summary
Annually in the Netherlands 15.000 elderly patients (55 years or older) are
admitted to hospital because of a hip fracture. Of these patients,
approximately 3500 are discharged to a skilled nursing home to take part in an
inpatient geriatric rehabilitation program (GR). The functional prognosis after
a hip fracture is poor with a 1 year mortality rate of 20-30%. A great deal of
the patients experience permanent functional disability, with only 40%
recovering to their pre-fracture functional state. Factors that influence
functional outcome are pre-fracture functional state (activities in daily
living and walking function), age, sex, cognitive function, depression and fear
of falling. Fear of falling possibly has a greater effect on functional outcome
than pain or depression. Currently there are no programs known available aimed
at reducing fear of falling among hip fracture patients admitted to geriatric
rehabilitation units.
Study objective
To determine the effects, feasibility and costs of a multi-component cognitive
behavioural intervention for reducing fear of falling and associated activity
restriction in hip fracture patients admitted for geriatric rehabilitation.
Study design
Blinded cluster randomised controlled trial.
Intervention
The control group receives care as usual, as embedded in the care pathway
geriatric rehabilitation for hip fracture patients. The intervention group
receives the FIT-HIP intervention integrated in the usual care. The FIT-HIP
intervention consists of various elements of cognitive behaviour therapy
(guided exposure, psycho-education and cognitive restructuring). This will be
combined with exercise training in the physiotherapy sessions.
Study burden and risks
The FIT-HIP intervention consists of cognitive behavioural therapy and is not
associated with additional health risk for the patient.
Potential benefits of the FIT-HIP intervention are reduction of fear of falling
and a better functional recovery (gait / mobility) during the rehabilitation.
The burden of participation is time: approximately 75 minutes at admission to
and at discharge from geriatric rehabilitation (interview/self administerd
questionnaires and functional testing of mobility). The follow up consists of
a self-administered questionnaire (duration +/- 35 min), sent to the home
address by post, two times after discharge from geriatric rehabilitation. In a
selection of patients (N=20) from the intervention group, a qualitative group
interview will be performed to assess feasibility of the intervention (duration
+/- 1 hour).
Hippocratespad 21
Leiden 2333 RC
NL
Hippocratespad 21
Leiden 2333 RC
NL
Listed location countries
Age
Inclusion criteria
- Aged 65 years or older
- Admitted to a geriatric rehabilitation unit for rehabilitation due to a hip fracture
- Concerned to fall. This is measured by the one item fear of falling question (answering *positively* in the category sometimes, often or very often)
Exclusion criteria
- The patient has a condition interfering with learning ability, such as:
1.A diagnosis of dementia or score on the 'hetero-anamnesis list cognition' > 1, suggesting
pre-morbid cognitive problems
2.A major psychiatric disease
3. Insufficient mastery of Dutch language
- The patient has a limited life expectancy
- The patient has a pathological hip fracture
- Pre-fracture Barthel-index score < 15 (as a measure of ADL dependency)
Design
Recruitment
metc-ldd@lumc.nl
metc-ldd@lumc.nl
metc-ldd@lumc.nl
metc-ldd@lumc.nl
metc-ldd@lumc.nl
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL54171.058.15 |