Department of Geriatrics, St. Mary's Hospital, Waterbury, Connecticut, USA.
UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
J Am Geriatr Soc. 2022 Nov;70(11):3087-3095. doi: 10.1111/jgs.17930. Epub 2022 Jul 20.
Community-dwelling older adults experiencing hip fracture often fail to achieve adequate walking capacity following surgery and rehabilitation. Effects of psychological factors on post-fracture walking capacity are poorly understood. Accordingly, this paper investigates effects of psychological resilience on observed walking capacity measures in older adults following hip fracture, controlling for important covariates.
Data were drawn from the Community Ambulation Project, a clinical trial of 210 community-dwelling adults aged ≥60 years who experienced a minimal trauma hip fracture and were randomized to one of two 16-week home-based physical therapist-guided interventions. Psychological resilience was measured at study baseline using the 6-item Brief Resilience Scale (BRS); scores were classified into groups in order to distinguish levels of self-reported resilience. Walking capacity was assessed at study baseline and 16 weeks later using 4-Meter Gait Speed (4MGS), 50-Foot Walk Test (50FWT), and 6-Minute Walk Distance (SMWD). In multivariate analyses of covariance in which 16-week follow-up values of each walking measure were outcomes, covariates included clinical trial arm, gender, age, and baseline values of: walking measure corresponding to the outcome; body mass index; depressive symptom severity; degree of psychological optimism; cognitive status; informal caregiver need; and days from hospital admission to randomization.
Increases between baseline and 16 weeks later in mean gait speed in meters/sec (m/s) and walking distance in meters (m) in 4MGS, 50FWT and SMWD were 0.06 m/s (p = 0.061), 0.11 m/s (p < 0.01), and 25.5 m (p = 0.056) greater, respectively, in the most resilient BRS group compared to the least resilient BRS group.
Higher levels of psychological resilience were associated with greater walking speed and distance. Psychological resilience represents a potentially clinically important pathway and intervention target, toward the goal of improving walking capacity among older adults known to have substantial residual disability following hip fracture.
社区居住的老年髋部骨折患者在手术后和康复期间常常无法达到足够的步行能力。心理因素对骨折后步行能力的影响知之甚少。因此，本文研究了心理弹性对髋部骨折后老年人观察到的步行能力测量的影响，同时控制了重要的协变量。
数据来自社区活动项目，这是一项针对 210 名年龄在 60 岁及以上、经历过轻微创伤性髋部骨折且随机分配到两种 16 周家庭物理治疗师指导干预措施之一的社区居民的临床试验。心理弹性在研究基线时使用 6 项简明韧性量表（BRS）进行测量；根据自我报告的韧性水平将分数分为不同的组别。步行能力在研究基线和 16 周后使用 4 米步态速度（4MGS）、50 英尺步行测试（50FWT）和 6 分钟步行距离（SMWD）进行评估。在多元协方差分析中，每个步行测量的 16 周随访值作为结果，协变量包括临床试验臂、性别、年龄和以下基线值：与结果对应的步行测量值；体重指数；抑郁症状严重程度；心理乐观程度；认知状态；非正规照顾者需求；以及从入院到随机分组的天数。
在 4MGS、50FWT 和 SMWD 中，与基线相比，16 周后平均步速（m/s）和步行距离（m）的平均增加分别为 0.06m/s（p=0.061）、0.11m/s（p<0.01）和 25.5m（p=0.056），在最具韧性 BRS 组中分别高于最不具韧性 BRS 组。
较高的心理韧性水平与较高的步行速度和距离相关。心理韧性代表了一种潜在的临床重要途径和干预靶点，旨在改善髋部骨折后已知存在大量残余残疾的老年人的步行能力。
