Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany.
Age Ageing. 2020 Aug 24;49(5):771-778. doi: 10.1093/ageing/afaa050.
fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT.
one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention.
in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45).
the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.
跌倒及其相关的自我效能感降低是跌倒的常见后果，并与康复效果较差有关。为了解决这些心理后果，老年住院康复增加了认知行为干预（“步步为营”），并在 RCT 中进行了评估。
115 名髋部和骨盆骨折患者（年龄=82.5 岁，70%为女性）被随机分配到干预组或对照组。干预组在住院康复期间增加了 8 次额外的个体治疗，1 次家访和 4 次电话随访，随访时间为出院后 2 个月。两组均接受老年住院康复治疗。主要结局是入院后、出院前和干预后 1 个月的跌倒相关自我效能感（短期跌倒效能感量表-国际版）和身体活动，以每日行走时间（activPAL3™传感器）衡量。
在协方差分析中，干预组患者的跌倒相关自我效能感显著提高（P=0.025，d=-0.42），但在干预后 1 个月的总日行走时间（P=0.688，d=0.07）与对照组相比没有差异。在次要结局中，干预组在“感知管理跌倒的能力”（P=0.031，d=0.41）、“身体表现”（简易体能测试）（P=0.002，d=0.58）和“跌倒次数”（P=0.029，d=-0.45）方面也有显著的效果。
该干预措施提高了心理和身体表现测量值，但并未增加每日行走时间。对于干预的住院部分，进一步研究需要达到有效强度的最小强度很有意义。出院后改善身体活动的时间和组成部分应重新考虑。
