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Open Access 01-12-2021 | Anxiety | Research article

Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention

Authors: Maaike N. Scheffers-Barnhoorn, Monica van Eijk, Jos M. G. A. Schols, Romke van Balen, Gertrudis I. J. M. Kempen, Wilco P. Achterberg, Jolanda C. M. van Haastregt

Published in: BMC Geriatrics | Issue 1/2021

Abstract

Background

This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This ‘FIT-HIP intervention’ is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention.

Methods

This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients’ adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists).

Results

Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients’ adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0–10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists’ limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol.

Conclusions

The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention’s feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring.

Trial registration

Netherlands Trial Register: NTR5695 (7 March 2016).

Available only for authorised users

Handoll HH, Cameron ID, Mak JC, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2009;4:Cd007125.

Magaziner J, Chiles N, Orwig D. Recovery after hip fracture: interventions and their timing to address deficits and desired outcomes--evidence from the Baltimore hip studies. Nestle Nutr Institute Workshop Series. 2015;83:71–81. https://doi.org/10.1159/000382064.CrossRef

Visschedijk J, Achterberg W, Van Balen R, Hertogh C. Fear of falling after hip fracture: a systematic review of measurement instruments, prevalence, interventions, and related factors. J Am Geriatr Soc. 2010;58(9):1739–48. https://doi.org/10.1111/j.1532-5415.2010.03036.x.CrossRefPubMed

Visschedijk J, van Balen R, Hertogh C, Achterberg W. Fear of falling in patients with hip fractures: prevalence and related psychological factors. J Am Med Dir Assoc. 2013;14(3):218–20. https://doi.org/10.1016/j.jamda.2012.10.013.CrossRefPubMed

Tinetti ME, Powell L. Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol. 1993;48:35–8.CrossRef

Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37(1):19–24. https://doi.org/10.1093/ageing/afm169.CrossRefPubMed

Oude Voshaar RC, Banerjee S, Horan M, et al. Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people. Psychol Med. 2006;36(11):1635–45. https://doi.org/10.1017/S0033291706008270.CrossRefPubMed

Bower ES, Wetherell JL, Petkus AJ, Rawson KS, Lenze EJ. Fear of falling after hip fracture: prevalence, course, and relationship with one-year functional recovery. Am J Geriatr Psychiatry. 2016;24(12):1228–36. https://doi.org/10.1016/j.jagp.2016.08.006.CrossRefPubMedPubMedCentral

Ko Y, Lee J, Kim SY, Baek SH. Identification of factors related to functional decline of Korean older adults after hip fracture surgery: a cross-sectional study. Res Gerontol Nurs. 2019;12:1–9.CrossRef

10.

Holstege MS, Caljouw MAA, Zekveld IG, van Balen R, de Groot AJ, van Haastregt JCM, et al. Successful geriatric rehabilitation: effects on Patients’ outcome of a National Program to improve quality of care, the SINGER study. J Am Med Dir Assoc. 2017;18(5):383–7. https://doi.org/10.1016/j.jamda.2016.10.011.CrossRefPubMed

11.

Achterberg WP, Cameron ID, Bauer JM, Schols JM. Geriatric rehabilitation-state of the art and future priorities. J Am Med Dir Assoc. 2019;20(4):396–8. https://doi.org/10.1016/j.jamda.2019.02.014.CrossRefPubMed

12.

Scheffers-Barnhoorn MN, van Eijk M, van Haastregt JCM, et al. Effects of the FIT-HIP Intervention for Fear of Falling After Hip Fracture: a Cluster-Randomized Controlled Trial in Geriatric Rehabilitation. J Am Med Dir Assoc. 2019;20(7):857–865.e852.CrossRef

13.

Zijlstra GA, Tennstedt SL, van Haastregt JC, van Eijk JT, Kempen GI. Reducing fear of falling and avoidance of activity in elderly persons: the development of a Dutch version of an American intervention. Patient Educ Couns. 2006;62(2):220–7. https://doi.org/10.1016/j.pec.2005.07.005.CrossRefPubMed

14.

Zijlstra GA, van Haastregt JC, Ambergen T, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(11):2020–8. https://doi.org/10.1111/j.1532-5415.2009.02489.x.CrossRefPubMed

15.

Dorresteijn TA, Zijlstra GA, Ambergen AW, Delbaere K, Vlaeyen JW, Kempen GI. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr. 2016;16(1):2. https://doi.org/10.1186/s12877-015-0177-y.CrossRefPubMedPubMedCentral

16.

Liu TW, Ng GYF, Chung RCK, Ng SSM. Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis. Age Ageing. 2018;47(4):520–7. https://doi.org/10.1093/ageing/afy010.CrossRefPubMed

17.

Chua CHM, Jiang Y, Lim S, Wu VX, Wang W. Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: a systematic review and meta-analysis. J Adv Nurs. 2019;75(12):3299–315. https://doi.org/10.1111/jan.14150.CrossRefPubMed

18.

Wetherell JL, Bower ES, Johnson K, Chang DG, Ward SR, Petkus AJ. Integrated exposure therapy and exercise reduces fear of falling and avoidance in older adults: a randomized pilot study. Am J Geriatr Psychiatry. 2018;26(8):849–59. https://doi.org/10.1016/j.jagp.2018.04.001.CrossRefPubMedPubMedCentral

19.

Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol Ser B Psychol Sci Soc Sci. 1998;53(6):P384–92.

20.

Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidence-based program to manage concerns about falls in older adults. The Gerontologist. 2013;53(5):839–49. https://doi.org/10.1093/geront/gns142.CrossRefPubMed

21.

Scheffers-Barnhoorn MN, van Haastregt JC, Schols JM, et al. A multi-component cognitive behavioural intervention for the treatment of fear of falling after HIP fracture (FIT-HIP): protocol of a randomised controlled trial. BMC Geriatr. 2017;17(1):71. https://doi.org/10.1186/s12877-017-0465-9.CrossRefPubMedPubMedCentral

22.

Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract. 2005;6(2):134–47. https://doi.org/10.1177/1524839904273387.CrossRefPubMed

23.

Wilson DK, Griffin S, Saunders RP, Kitzman-Ulrich H, Meyers DC, Mansard L. Using process evaluation for program improvement in dose, fidelity and reach: the ACT trial experience. Int J Behav Nutr Phys Act. 2009;6(1):79. https://doi.org/10.1186/1479-5868-6-79.CrossRefPubMedPubMedCentral

24.

Steckler ALL, Israel B. Process evaluation for public health interventions and research: Wiley; 2002.

25.

Meijer R, van Limbeek J, de Haan R. Development of the stroke-unit discharge guideline: choice of assessment instruments for prediction in the subacute phase post-stroke. Int J Rehabil Res. 2006;29(1):1–8. https://doi.org/10.1097/01.mrr.0000175269.59788.41.CrossRefPubMed

26.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Admin Pol Ment Health. 2015;42(5):533–44. https://doi.org/10.1007/s10488-013-0528-y.CrossRef

27.

Pfeiffer K, Kampe K, Klenk J, Rapp K, Kohler M, Albrecht D, 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):771–8. https://doi.org/10.1093/ageing/afaa050.CrossRefPubMed

28.

Dorresteijn TA, Zijlstra GA, Delbaere K, van Rossum E, Vlaeyen JW, Kempen GI. Evaluating an in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail community-dwelling older people: design of a randomised control trial [NCT01358032]. BMC Health Serv Res. 2011;11(1):228. https://doi.org/10.1186/1472-6963-11-228.CrossRefPubMedPubMedCentral

29.

Wetherell JL, Johnson K, Chang D, Ward SR, Bower ES, Merz C, et al. Activity, balance, learning, and exposure (ABLE): a new intervention for fear of falling. Int J Geriatric Psychiatry. 2016;31(7):791–8. https://doi.org/10.1002/gps.4393.CrossRef

30.

Dorresteijn TA, Rixt Zijlstra GA, Van Haastregt JC, Vlaeyen JW, Kempen GI. Feasibility of a nurse-led in-home cognitive behavioral program to manage concerns about falls in frail older people: a process evaluation. Res Nurs Health. 2013;36(3):257–70. https://doi.org/10.1002/nur.21534.CrossRefPubMed

31.

Driver C, Kean B, Oprescu F, Lovell GP. Knowledge, behaviors, attitudes and beliefs of physiotherapists towards the use of psychological interventions in physiotherapy practice: a systematic review. Disabil Rehabil. 2017;39(22):2237–49. https://doi.org/10.1080/09638288.2016.1223176.CrossRefPubMed

32.

Nielsen M, Keefe FJ, Bennell K, Jull GA. Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists’ perceptions and experiences. Phys Ther. 2014;94(2):197–209. https://doi.org/10.2522/ptj.20130047.CrossRefPubMed

33.

Kampe K, Kohler M, Albrecht D, Becker C, Hautzinger M, Lindemann U, et al. Hip and pelvic fracture patients with fear of falling: development and description of the “step by step” treatment protocol. Clin Rehabil. 2017;31(5):571–81. https://doi.org/10.1177/0269215517691584.CrossRefPubMed

34.

van Haastregt JC, Zijlstra GA, van Rossum E, van Eijk JT, de Witte LP, Kempen GI. Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community-living older people: a process evaluation. BMC Health Serv Res. 2007;7(1):156. https://doi.org/10.1186/1472-6963-7-156.CrossRefPubMedPubMedCentral

35.

Visschedijk JH, Caljouw MA, Bakkers E, van Balen R, Achterberg WP. Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities. BMC Geriatr. 2015;15(1):161. https://doi.org/10.1186/s12877-015-0158-1.CrossRefPubMedPubMedCentral

36.

van Balen R, Gordon AL, Schols JMGA, Drewes YM, Achterberg WP. What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus. Eur Geriatric Med. 2019;10(6):977.CrossRef

37.

Visschedijk JH, Terwee CB, Caljouw MA, Spruit-van Eijk M, van Balen R, Achterberg WP. Reliability and validity of the falls efficacy scale-international after hip fracture in patients aged >/= 65 years. Disabil Rehabil. 2015;37(23):2225–32. https://doi.org/10.3109/09638288.2014.1002573.CrossRefPubMed

38.

Bower ES, Wetherell JL, Petkus AJ, Lenze EJ. Neuroticism predicts fear of falling after hip fracture. Int J Geriatr Psychiatry. 2020;35(5):498.CrossRef

39.

Adamczewska N, Nyman SR. A new approach to fear of falls from connections with the posttraumatic stress disorder literature. Gerontol Geriatric Med. 2018;4:2333721418796238.CrossRef

40.

Young WR, Mark WA. How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations. Gait Posture. 2015;41(1):7–12. https://doi.org/10.1016/j.gaitpost.2014.09.006.CrossRefPubMed

41.

Allison LK, Painter JA, Emory A, Whitehurst P, Raby A. Participation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults. J Geriatr Phys Ther. 2013;36(1):13–23. https://doi.org/10.1519/JPT.0b013e3182493d20.CrossRefPubMed

Title: Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention
Authors: Maaike N. Scheffers-Barnhoorn
Monica van Eijk
Jos M. G. A. Schols
Romke van Balen
Gertrudis I. J. M. Kempen
Wilco P. Achterberg
Jolanda C. M. van Haastregt
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Anxiety
Published in: BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-021-02170-5

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Abstract

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Methods

Results

Conclusions

Trial registration

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