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), Maastricht University, Maastricht, The Netherlands.
BMC Geriatr. 2021 Apr 1;21(1):224. doi: 10.1186/s12877-021-02170-5.
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.
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).
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.
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.
Netherlands Trial Register: NTR5695 (7 March 2016).
本研究描述了一种针对髋部骨折后跌倒恐惧（FoF）的干预措施的过程评估，该干预措施在荷兰的老年康复住院环境中实施。这个“FIT-HIP 干预”是一种多成分认知行为干预，由物理治疗师实施，并嵌入在老年康复的常规护理中。先前的研究（集群随机对照试验）表明，与常规护理相比，该干预措施没有带来有益的效果。本研究的目的是深入了解与干预过程相关的因素，这些因素可能影响了干预的效果。
本过程评估采用观察性前瞻性研究设计进行。基于从会议记录、评估问卷和访谈中得出的定量和定性数据，我们研究了：1] 招募和覆盖面；2] 按照方案执行的情况；3] 患者的依从性；4] 患者和促进者对干预的看法。本研究的参与者为：a）来自 6 个老年康复病房的患者，他们被邀请参加干预（39 名年龄≥65 岁、髋部骨折并伴有 FoF 的成年人）；b）干预促进者（14 名物理治疗师和 8 名心理学家，为物理治疗师提供指导）。
36 名患者在老年康复住院期间完成了干预。除了认知重构和电话强化（并非所有患者都接受）外，该干预按照方案执行的程度相当好。患者对干预的依从性非常好，患者对干预的评价也很高（平均 8.1 分，满分 10 分）。尽管大多数促进者认为该干预是可行的，但发现了一些执行方案干预的重要障碍，如 FoF 程度有限（可能与干预时机有关）和物理治疗师在认知重构方面的经验有限。
FIT-HIP 干预措施的可行性有限，这可能解释了其在降低 FoF 方面缺乏效果的原因。为了提高干预措施的可行性，我们建议选择有适应不良 FoF（即导致活动受限）的患者，在干预时机上更具灵活性，并为物理治疗师提供更多支持，以进行认知重构。
荷兰试验注册中心：NTR5695（2016 年 3 月 7 日）。
