RESUMEN
Fall accidents among older adults can be devastating events that, in addition to their physical consequences, lead to disabling anxiety warranting the attention of mental health practitioners. This article presents "Back on My Feet," an exposure-based cognitive-behavioral therapy (CBT) protocol that is designed for older adults with posttraumatic stress disorder (PTSD), subthreshold PTSD, or fear of falling resulting from a traumatic fall. The protocol can be integrated into care once patients have been discharged from hospital or rehabilitation settings back to the community. Following a brief description of its development, the article presents a detailed account of the protocol, including patient evaluation and the components of the eight home-based sessions. The protocol addresses core symptoms of avoidance, physiological arousal/anxiety, and maladaptive thought patterns. Because older patients face different coping challenges from younger patients (for whom the majority of evidence-based CBT interventions have been developed), the discussion ends with limitations and special considerations for working with older, injured patients. The article offers a blueprint for mental health practitioners to address the needs of patients who may present with fall-related anxiety in primary care and other medical settings. Readers who wish to develop their expertise further can consult the online appendices, which include a clinician manual and patient workbook, as well as guidance on additional resources.
RESUMEN
OBJECTIVE: To measure functional recovery after hip fracture in the subacute setting. BACKGROUND: There are over 340,000 hip fractures that occur in the United States annually. Three out of five hospitalizations attributable to injury among persons over 75 were for fractures. Greater than 50% were hip fractures. PURPOSE: The purpose of this study is to describe the functional recovery after hip fracture in the subacute setting utilizing performance-based measures (PBMs). METHOD: This is a prospective observational cohort. DATA ANALYSIS: Descriptive statistics were used for baseline characteristics. Repeated measures analysis using a Bonferroni correction was utilized to compare admission and discharge PBM scores. RESULTS: Eighty residents were enrolled in the study, of which seven were withdrawn because of medical complications and one subject died within 1 week of admission. Data were analyzed for 72 subjects. There were 59 women and 13 men ranging in age from 63-99. Mean age was 85.3. The patients' profiles were as follows: 53% lived alone, 63% were Medicare recipients, 50% used an assistive device before hip fracture, 46% sustained a femoral neck fracture, 57% underwent a bipolar hemiarthroplasty, 90% received epidural anesthesia, and 90% had a weight-bearing status as weight-bearing was tolerated. The PBM results are as follows: [table: see text] CONCLUSION: There was a significant improvement between admission and discharge TUG test, Tinetti gait and balance test, and 6MW test scores in patients who underwent surgical repair of a hip fracture after a fall.
RESUMEN
We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-component intervention designed to improve functional recovery after hip fracture. One hundred seventy-six patients who underwent surgery for a primary unilateral hip fracture were assigned randomly to receive usual care (control arm, n = 86) or a brief motivational videotape, supportive peer counseling, and high-intensity muscle-strength training (intervention arm, n = 90). Between-group differences on the physical functioning, role-physical, and social functioning domains of the SF-36 were assessed postoperatively at 6 months. At the end of the trial, 32 intervention and 27 control patients (34%) completed the 6-month outcome assessment. Although patient compliance with all three components of the intervention was uneven, over 90% of intervention patients were exposed to the motivational videotape. Intervention patients experienced a significant (P = 0.03) improvement in the role-physical domain (mean change, -11 +/- 33) compared to control patients (mean change, -37 +/- 41). Change in general health (P = 0.2) and mental health (P = 0.1) domain scores was also directionally consistent with the study hypothesis. Although our findings are consistent with previous reports of comprehensive rehabilitation efforts for hip fracture patients, the trial was undermined by high attrition and the possibility of self-selection bias at 6-month follow-up. We discuss the methodological challenges and lessons learned in conducting a randomized controlled trial that sought to implement and assess the impact of a complex intervention in a population that proved difficult to follow up once they had returned to the community.
RESUMEN
Decisions made regarding resumption of driving after total hip arthroplasty may be determined by a combination of factors including driving reaction time and when postsurgical precautions need no longer be adhered to. Ninety patients, ranging in age from 34 to 85 years old were recruited after total hip arthroplasty to measure driving reaction time preoperatively and from 1 to 52 weeks postoperatively. Driving reaction time worsened 1 week postoperatively for patients who had a right hip arthroplasty. The driving reaction time then improved up to 1 year postoperatively. Patients who had a left arthroplasty improved from 1 week postoperative. In general, patients reach their preoperative driving reaction time 4 to 6 weeks postoperatively and continue to improve.