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Physical Function and Fear of Falling After Hip Fracture Rehabilitation in the Elderly

Petrella, Robert J., MD, PhD; Payne, Michael, MSc; Myers, Anita, PhD; Overend, Tom, PhD; Chesworth, Bert, PhD

American Journal of Physical Medicine & Rehabilitation: March-April 2000 - Volume 79 - Issue 2 - p 154-160
CME Article · 2000 Series · Number 4: Falls & Fractures

Objective: The purpose of this study was to determine the relationship between physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program.

Design: We used a prospective cohort study over 12 mo to determine the effect of a specialized hip fracture rehabilitation program in a geriatric hospital on physical function and fear of falling. Fifty-six patients were admitted consecutively from acute care. Physical function was assessed using the Functional Independence Measure, and fall-related self-efficacy was measured using two scales: the Falls-Efficacy scale and the Activities-Specific Balance Confidence scale. We also used the Vitality scale to measure quality of life. All measures, represented by change scores, were determined at the beginning and end of the patients' rehabilitation programs.

Results: Significant improvement in physical function and fall self-efficacy was observed. The Vitality scale was also improved after rehabilitation. The Falls-Efficacy scale appeared to be more sensitive to change than the Activities-Specific Balance Confidence scale, whereas no correlation was found between changes in the fall-related self-efficacy measures and the Functional Independence Measure.

Conclusions: These findings may represent a discrepancy between attention of the rehabilitation program on functional outcomes and less emphasis on confidence building behaviors. Restrictions in function from a fear of falling may negate any gains made through rehabilitation, and this could limit the long-term success of these programs and patient outcomes after hip fracture.

From the Faculties of Medicine, Departments of Family Medicine (RJP) and Epidemiology and Biostatistics (BC), and Health Sciences, Schools of Kinesiology (RJP, MP) and Physical Therapy (TO, BC), The University of Western Ontario London, Ontario, and the Department of Health Studies and Gerontology (AM), University of Waterloo, Waterloo, Ontario.

Reprints: Robert J. Petrella, MD, PhD, The Centre for Activity and Ageing, 1490 Richmond St N, London, Ontario, Canada N6G 2M3.

Disclosures: Funded by research grants from the Parkwood Hospital Foundation and the Imperial Oil Geriatric Award of the Lawson Research Institute, London, Ontario, Canada.

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© 2000 Lippincott Williams & Wilkins, Inc.