After Hip or Pelvic Fracture, Cognitive Behavioral Intervention May Be Key

Older adults who are recovering from a hip or pelvic fracture may experience more positive outcomes if their rehabilitation includes a cognitive behavioral intervention, according to findings of a new study. This determination comes after the researchers found that such an intervention improved participants’ psychological and physical performance measures.

“Fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes,” the researchers wrote. “To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioral intervention and evaluated in a [randomized controlled trial].”

In all, 115 patients (age, 82.5 years; women, 70%) who had fractured their hip or pelvis and had been admitted to a geriatric inpatient rehabilitation were randomly assigned to either the intervention or control group. 

Both groups received geriatric inpatient rehabilitation. However, those in the intervention group were directed to complete 8 additional individual sessions during inpatient rehabilitation, 1 home visit, and 4 telephone calls over 2 months after discharge. 

The researchers assessed the participants’ fall-related self-efficacy (Short Falls Efficacy Scale-International) and physical activity, as measured by daily walking duration after admission to rehabilitation, before discharge and at 1 month after the intervention.

According to the covariance analyses, participants in the intervention group displayed a significant improvement in fall-related self-efficacy. However, they did not experience a difference in total daily walking duration at 1 month post-intervention compared with the control group. 

The intervention group also experienced significant improvements in their perceived ability to manage falls, their physical performance, and the number of falls they sustained.

“For the inpatient part of the intervention, further research on the required minimum intensity needed to be effective is of interest,” the researchers concluded. “Duration and components used to improve physical activity after discharge should be reconsidered.”

—Colleen Murphy

Reference:

Pfeiffer K, Kampe K, Klenk J, et al. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age Ageing. 2020;49(5):771-778. doi:10.1093/ageing/afaa050