FIT-HIP: Fear of Falling Intervention in Hip Fracture Geriatric Rehabilitation: a Cluster Randomized Controlled Trial

In the Netherlands, each year 17000 patients are admitted to the hospital because of a hip fracture, of which 3500 are being discharged for geriatric rehabilitation in skilled nursing facilities. Most of these patients are female and (very) old. In the first year after their fracture, approximately 30% of these patients will die, 25% will have significant functional decline in activities of daily living such as bathing and dressing, and approximately 38% to 50% need assistance to walk or are unable to walk at 12 months post–hip fracture. An important strategy with potential to improve recovery in older adults following a hip fracture is geriatric rehabilitation. However, despite an intensive geriatric rehabilitation program, a lot of patients do not recover to their earlier functional status and remain impaired in their activities, societal participation, and quality of life. One of the factors explaining disappointing results in GR, is fear of falling. Fear of falling is defined as ‘a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing’. In earlier studies, we showed that more than half of hip fracture patients in geriatric rehabilitation suffer from fear of falling and that it is associated with higher anxiety, lower self-efficacy and less mobility. We showed that fear of falling is already present on admission to geriatric rehabilitation, but also hampers activities after discharge. Exercise training and performing tasks and activities are an essential part of rehabilitation after a hip fracture. When a person has fear of falling, adherence to these exercise tasks and therefore recovery, is seriously threatened. Developing successful interventions to reduce fear of falling and to motivate individuals after a hip fracture to adhere to regular exercise programs has the potential to improve recovery and overall quality of life to a great extend, as members of our research group have shown in several studies in the general population. At present, no programs are available aimed at reducing fear of falling among hip fracture patients admitted to geriatric rehabilitation units. In Maastricht, the Netherlands, in the past decade, the Dutch version of the multi-component intervention “A Matter of Balance” has been developed based on the program of Tennsted and colleagues. The program proved to be (cost-) effective in reducing fear of falling associated avoidance of activity, among community living elderly persons in the Netherlands. Both a group version and an individual version of the intervention is available. Based on this successful intervention an adjusted version of this program for hip fracture patients will be developed and evaluated in the present study. This FIT-HIP intervention is a cognitive behavioral multi component intervention directed at reducing fear of falling and avoidance of activity and increasing self-efficacy and daily functioning among hip fracture patients admitted to a geriatric rehabilitation unit. The program is evaluated in a cluster randomized controlled trial. The evaluation consists of an effect evaluation, process evaluation and concise economical evaluation. Primary outcomes measures of the effect evaluation are the Tinetti Performance Oriented Mobility Assessment and the Falls Efficacy Scale international. In the process evaluation the feasibility of the program and the opinion of patients and care professionals on the intervention, is assessed. In the economical evaluation the costs of the intervention and costs of health care utilization are assessed. The primary research target for this study is to determine the effects, feasibility and costs of an intervention in hip fracture patients admitted to a geriatric rehabilitation unit.