Effectiveness of a Rehabilitation Self-Efficacy Program on Postoperative Outcomes in Older Adults with Hip Fracture: A Randomized Controlled Trial
DOI:
https://doi.org/10.60099/prijnr.2025.269063Keywords:
Activity of daily living, Exercise, Hip fracture, Muscle strength, Older adults, Pain, Quality of life, Rehabilitation Program, Self-efficacyAbstract
Older adults with hip fractures who have undergone surgery require long-term care to relieve pain, improve physical function, and enhance their quality of life. Thus, continuing care postoperatively is imperative for quick recovery. This randomized controlled trial examined the effectiveness of a rehabilitation self-efficacy program to enhance postoperative outcomes, including self-efficacy exercise, pain, activities of daily living, strength of muscles, and quality of life. Fifty-eight Thai older adults were randomly assigned to the intervention (n = 29) or control groups (n = 29). The intervention group received the eight-week intervention, while the control group received only usual care. Data were collected through questionnaires including the Self-efficacy Quadriceps and Gluteal Exercise Questionnaire, Numeric Pain Rating Scale, Modified Barthel Activity of Daily Living Index, and Mini-osteoarthritis of Knee and Hip Quality of Life Questionnaire. A hand-held Dynamometry was used to assess quadriceps muscle strength. Data were analyzed by descriptive statistics and a two-way multivariate analysis of variance with repeated measures.
The results revealed that the intervention group showed significantly higher self-efficacy in exercise and activities of daily living as well as reduction of pain, than the control group at discharge, and 2 and 8 weeks after hospital discharge. The quadriceps muscle strength and quality of life of the intervention group were significantly higher than that of the control group at 8 weeks after hospital discharge. It can be concluded that this program is effective. Nurses should integrate into this program in practice to enhance overall care quality for older adults with hip fractures. However, further testing in various settings is required before the program is widely used.
References
Chan LL, Ho YY, Taylor ME, Mcveigh C, Jung S, Armstrong E, et al. Incidence of fragility hip fracture across the Asia-pacific region: a systematic review. Arch Gerontol Geriatr. 2024;123:1-11. doi: 10.1016/j.archger.2024.105422.
Thai Health Promotion Foundation. Incidence of older adults with hip fracture. [Internet]. 2024 [cited 2024 Aug 30]. Available from: http://www.hfocus.org/content/2024/08/31480 (in Thai).
Guerra S, Ellmers T, Turabi R, Law M, Chauhan A, Milton-Cole R, Godfrey E, Sheehan KJ. Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review. Eur Geriatr Med. 2024 Apr;15(2):305-332. doi: 10.1007/s41999-024-00936-9.
Nilsson U, Jaensson M, Hugelius K, Arakelian E, Dahlberg K. A journey to a new stable state further development to the postoperative recovery concept from day surgical perspective: a qualitative study. BMJ Open. 2020;10(9):e037755. doi: 10.1136/bmjopen- 2020-037755.
The Healthcare Accreditation Institute. Guidelines for the surgical management of hip fractures in older adults. [Internet]. 2023 [cited 2024 Jun 2]. Available from: https://www.si.mahidol.ac.th/th/division/healthpolicy/admin/download_files/2_145_1ytgEti.pdf (in Thai).
Che Y, Qian Z, Chen Q, Chang R, Xie X, Hao YF. Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients. BMC Musculoskelet Disord. 2023;24(817):1-8. doi: 10.1186/s12891-023-6806-y.
Amarilla-Donoso FJ, Lopes-Espuela F, Roncero-Martin R, Leal-Hernandez O, Puerto-Parejo LM, Aliaga-Vra I, et al. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes. 2020;18(71):1-10. doi: 10.1186/s12955-020-01314-2.
Araiza-Nava B, Méndez-Sánchez L, Clark P, Peralta-Pedrero ML, Javaid MK, Calo M, Martínez-Hernández BM, Guzmán-Jiménez F. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporos Int. 2022;33(7):1429-1444. doi: 10.1007/s00198-022-06346-6.
Southwell J, Potter C, Wyatt D, Sadler E, Sheehan KJ. Older adults' perceptions of early rehabilitation and recovery after hip fracture surgery: a UK qualitative study. Disabil Rehabil. 2022;44(6):940-947. doi: 10.1080/09638288.2020.1783002.
Huang C, Pan P, Chiang Y, Yang S. (2021). A rehabilitation-based multidisciplinary care model reduces hip fracture mortality in older adults. J Multidiscip Healthc. 2021;14:2741-7. doi:10.2147/JMDH.S331136.
Lee H, Lee S. Effectiveness of multicomponent home-based rehabilitation in elderly patients after hip fracture surgery: A randomized controlled trial. J of Personalized Med. 2022;12(4):1-12. doi:10.3390/jpm12040649.
Ramadi A, Ezeugwu VE, Weber S, Funabashi M, Lima CA, Perracini MR, Beaupre LA. Progressive resistance training program haracteristics in rehabilitation programs following hip fracture: a meta-analysis and meta-regression. Geriatr Orthop Surg Rehabil. 2022;13:1-14. doi:10.1177/21514593221090799.
Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman; 1997.
Fernandes JB, Ferreira N, Domingos J, Ferreira R, Amador C, Pardal N, et al. Health professionals’ motivational strategies to enhance adherence in the rehabilitation of people with lower limb fractures: Scoping Review. 2023;20(7050):1-14. doi.org/10.3390/ijerph20227050.
Jiale XU, Liqin FU, Hong WU, Jiaojiao Z, Jing WU. Mediating effect of rehabilitation self-efficacy on perceived social support and rehabilitation exercise adherence in hospitalized patients after hip/knee arthroplasty. J Shanghai Jiao Tong Uni. 2024;44(8):959-67. doi:10.3969/j.issn.1674-8115.2024.08.004
Sripiman S, Thiangchanya P, Purinthrapibal S. The effects of promoting self-care program to knowledge, self-efficacy, and self-care behaviors of patients with hip surgery at orthopedics ward, Songkhla Hospital. 2020;3(2):149-165 (in Thai).
Meng Y, Deng B, Liang X, Li J, Li L, Ou J, Yu S, Tan X, Chen Y, Zhang M. Effectiveness of self-efficacy-enhancing interventions on rehabilitation following total hip replacement: a randomized controlled trial with six-month follow-up. J Orthop Surg Res. 2022;17(225), 1-11. doi:10.1186/s13018-022-03116-2.
Omar A, Cumal A, Vellani S, Krassikova A, Lapenskie J, Bayly M, et.al. Health and social interventions to restore physical function of older adults post-hip fracture: a scoping review. BMJ Open. 2021;11(10):1-13. doi:10.1136/bmjopen-2021-053992.
Trongsakul S, Lambert R, Clark A, Wongpakaran N, Cross J. Development of the Thai version of Mini-Cog, a brief cognitive screening test. Geriatr Gerontol Int. 2015;15(5):594-600.
Jitapunkul S. Principles of geriatric medicine. 3rd. ed. Bangkok: Chulalongkorn University Press; 1998.
Ortiz-Pina M, Molina-Grcia P, Femia P, Ashe MC, Martin-Martin L, Salazar-Gravan SS, et.al. Effects of tele-rehabilitation compared with home-based in-person rehabilitation for older adult’s function after hip fracture. Int J Environ Res Public Health. 2021;18(10):1-13. doi:10.3390/ijerph18105493.
Guillemin F, Rat AC, Goetz C, Spitz E, Pouchot J, Coste J. The Mini-OAKHQOL for knee and hip osteoarthritis quality of life was obtained following recent shortening guidelines. J Clin Epidemiol. 2016;69:70-8. doi:10.1016/j.jclinepi.2015.06.010.
Aree-ue S, Kongsombun U, Roopsawang I, Youngcharoen P. Path model of factors influencing health-related quality of life among older people with knee osteoarthritis. Nurs Health Sci. 2019;21(3):345-51. doi:10.1111/nhs.12602.
Mumba MN, Mugoya G, Jurczyk A, Robb M. Associations among balance self-efficacy, physical function, and pain interference among community-dwelling older adults. Medsurg Nursing. 2020;29(1):19-26.
Yang J, Ou Y, Liu S, Lin C, Chang S, Lu Y, et.al. Exploring the effectiveness of PAC rehabilitation for elders with surgery: a retrospective study. Ther Clin Risk Manag. 2021;17:641-8. doi:10.2147/TCRM.S317218.
Schroeder H, Israeli A, Liebergall M, Or O, Ahmed WA, Paltiel O, et al. Home versus hospital rehabilitation of older adults following hip fracture yields similar patient-reported outcome measures. 2024;61:1-10. doi: 10.1177/00469580241230293.
Karlsson A, Lindelof N, Olofsson B, Berggren M, Gusttafson Y, Nordstrom P, et.al. Effects of geriatric interdisciplinary home rehabilitation on independence in activities of daily living in older people with hip fracture: a randomized controlled trial. Arch Phys Med Rehabil. 2020;101:571-8. doi:10.1016/j.apmr.2019.12.007.
Ropke A, Morville A, Moller TE, Delkus ECG, Juhl CB. Hip fracture rehabilitation program for older adults with hip fracture (HIP-REP) based on activity of daily living: a feasibility study. BMC Geriatr. 2022;22(270):1-13. doi:10.1186/s12877-022-03039-x.
Wijnen A, Hoogland J, Munsterman T, Gerritsma CLE, Dijkstra B, Zijlstra WP, et.al. Effectiveness of a home-based rehabilitation program after total hip arthroplasty driven by a tablet app and remote coaching: nonrandomized controlled trial combining a single-arm intervention cohort with historical controls. JMIR Rehabil Assist Technol. 2020;7(1):1-11. doi:10.2196/14139.
Zhang C, Xiao J. Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty. J Int Med Res. 2020;48(1):1-13. doi:10.1177/0300060519889718.
Liguori G. ACSM’s guidelines for exercise testing and prescription. 11th. ed. Philadelphia: Wolters Kluwer; 2021.
Betts JG, Young KA, Wise JA, Johnson E, Poe B, Kruse DH, et.al. Anatomy and physiology 2e. Texas: OpenStax; 2022.
McDonough CM, Harris-Hayes M, Kristensen MT, Overgaard JA, Herring TB, Kenny AM, et.al. Physical therapy management of older adults with hip fracture. J Orthop Sports Phys Ther. 2021;51(2):1. doi:10.2519/jospt.2021.0301.
Ninlerd C, Dungkong S, Phuangphay G, Amornsupak C, Narkbunnam R. Effect of home-based rehabilitation exercise program for elderly patients with femoral neck fracture after bipolar hemiarthroplasty. Siriraj Med J. 2020;72(4): 315-20.
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