Scheffers-Barnhoorn Maaike N, van Haastregt Jolanda C M, Schols Jos M G A, Kempen Gertrudis I J M, van Balen Romke, Visschedijk Jan H M, van den Hout Wilbert B, Dumas Eve M, Achterberg Wilco P, van Eijk Monica
Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
BMC Geriatr. 2017 Mar 20;17(1):71. doi: 10.1186/s12877-017-0465-9.
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.
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.
Netherlands Trial Register: NTR 5695 .
髋部骨折是老年人群中的常见损伤。尽管进行了手术修复及后续康复计划，但功能恢复往往有限，尤其是在患有多种疾病的个体中。这导致了高度的护理依赖以及随后对医疗服务的使用。由于避免活动及随之而来的行动受限，害怕跌倒对髋部骨折后的恢复有负面影响。尽管害怕跌倒在髋部骨折后非常普遍，但目前尚无结构化的治疗方案。本试验将评估在髋部骨折后的老年康复中，使用多成分认知行为干预（FIT-HIP）针对性治疗害怕跌倒是否可行且（具有成本）效益，以减少害怕跌倒及相关的活动受限，从而改善身体功能。
方法/设计：本多中心整群随机对照试验将在11个急性后期老年康复单元中，对因髋部骨折且害怕跌倒而入住多学科老年住院康复计划的老年患者进行。每个地点将招募15名参与者。招募地点将通过计算机随机分配到对照组，接受常规护理，或干预组，除常规护理外还接受FIT-HIP干预。FIT-HIP干预由物理治疗师进行，并将融入常规护理中。它包括认知行为疗法的各种要素，包括引导患者接触害怕的活动（参与者会避免的活动）。参与者和结果评估者对分组情况不知情。在老年康复出院后3个月和6个月进行随访测量。将评估干预的（成本）效益和可行性。主要结局指标是害怕跌倒和行动能力。
针对性治疗害怕跌倒可能会改善髋部骨折后的恢复以及身体和社会功能，从而为患者带来益处并降低医疗成本。本研究结果将有助于了解在髋部骨折后的（老年）康复中，害怕跌倒是否可改变，以及该干预是否可行。
荷兰试验注册库：NTR 5695
