Addressing Fear of Falling after Hip Fracture Remains a Challenge, Despite Advances in Rehab Services
A fear of falling (FoF) is common after a hip fracture and can impede functional recovery. Despite advances in acute care and post-acute rehabilitation services provided for hip fracture patients, long-term functional recovery after this event remains limited. A study in the July issue of JAMDA suggests that at least one cognitive behavioral intervention may not be effective in reducing this fear.
In Effects of the FIT-HIP Intervention for Fear of Falling after Hip Fracture: A Cluster Randomized Controlled Trial in Geriatric Rehabilitation, the authors assessed the benefit of the FIT-HIP intervention, a multi-component, cognitive behavioral intervention for geriatric rehabilitation. They compared the use of this intervention to usual care in this setting for patients recovering from a hip fracture. The FIT-HIP intervention consists of cognitive behavioral elements aimed at reducing FoF, including psychoeducation, guided exposure to feared activities, cognitive restructuring, and relapse prevention. Usual care includes mobility training, efforts to improve balance and gait, and exercise to boost muscle strength.
The results showed no significant differences between groups observed for primary outcome measures, specifically, a change in FoF and/or mobility function. The authors concluded, “The results of this study demonstrate that management of FoF after recent hip fracture remains challenging….We recommend that further research first focuses on exploring the ‘time-mediated effect’ of FoF after hip fracture, thereby gaining insight into how the direct physical consequences of hip fracture influence and relate to FoF.” They further observed that a better understanding of FoF after fracture “can help in adequately assessing when, and to what extent, treatment for FoF is required.”
This study was conducted by researchers in the Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Health Services Research and Care, Public Health Research Institute (CAPHRI), and Department of Family Medicine and Care, Maastricht University, Maastricht, the Netherlands; and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.