Elsevier

Geriatric Nursing

Volume 36, Issue 4, July–August 2015, Pages 273-280
Geriatric Nursing

Feature Article
Using a personalized DVD to prescribe an exercise program to older people post-hip fracture enhances adherence to the exercises – A feasibility study

https://doi.org/10.1016/j.gerinurse.2015.02.025Get rights and content

Abstract

Optimum recovery from hip fracture has been linked to the provision of effective rehabilitation, but levels of adherence vary among older patients. In this feasibility study a novel personalized DVD was designed for four participants, which delivered a 5 week tailored home exercise program (HEP), with the participant being videoed completing their exercises. Treatment fidelity of the DVD HEP was evaluated, including participants' perceptions of and response to the DVD-HEP, which was explored using diaries and interviews and analyzed thematically. Secondary outcome measures including exercise adherence and self-efficacy for exercise were analyzed using descriptive statistics. Levels of adherence to the HEP were 1.2–3.5 times more than the minimum prescribed dose and participants demonstrated higher levels of self-efficacy for exercise. Adherence was found to be enhanced by physical improvement, positive self-reflection about engagement in the DVD-HEP, the format of the DVD, and increased self-efficacy. Personalized DVDs may be a feasible method of promoting adherence to home exercise programs among older patients.

Introduction

Hip fractures are a substantial public health problem worldwide and result in substantial increased mortality.1, 2 Older people who fracture their hip have a 5 to almost 8 fold increase in all-cause mortality during the first 3 months after hip fracture and this risk does not return to a pre-fracture mortality rate even after 10 years of follow up.3 Hip fractures also result in functional decline, with up to 50% of patients having a disability in walking at 12 months post fracture,4, 5 and are also associated with loss of independence4 and moving into nursing home care.6

There is limited evidence about how to reduce the poor outcomes associated with hip fracture.7, 8 Optimum recovery has been linked to the provision of effective rehabilitation.6, 9 Although it is unclear what the ideal rehabilitation program should include, effective exercise programs have included higher exercise dose, muscle strengthening and functional exercises.5, 7, 8, 10 However, how to promote adherence to exercise in older people is unclear.11, 12, 13 Previous studies have confirmed that older people, including those with hip fracture, have low levels of adherence to exercise14, 15, 16 and identify perceived barriers to exercise which include lack of knowledge, depression, no interest, low outcome expectation, poor health, and low self-efficacy.11, 17, 18, 19, 20, 21

Digital video disc (DVD) technology has been used to provide training in adult populations and has shown generally positive effects in increasing adherence to exercises,22, 23, 24, 25 although the small number of studies and limitations in trial designs limit conclusive findings. However this approach has not been investigated in older patients after hip fracture. These studies also provided targeted exercise programs which used a single intervention approach applied to a sub-group of a population.26 No studies using DVD technology have designed a tailored or personalized exercise program using video of the patient themselves to construct the content of the DVD. This has the advantages of addressing specific characteristics of the individual in a tailored manner and may enhance training and self-efficacy by providing visual self-feedback, realistic exercise guidelines and a structured program.9, 27, 28, 29 Tailoring allows for personal and direct content presentation based on elements such as likes or dislikes, needs, and health behaviors and has been shown to have positive outcomes when compared to non-tailored interventions.30

The aim of this pilot study was to investigate the feasibility of providing a home exercise program (HEP) using a personalized DVD on exercise adherence among older people who had previously fractured their hip. In addition we evaluated the impact of the personalized DVD-HEP on participant's self efficacy and outcome expectancy for exercise, the amount of time spent engaging in physical activity, participants' health-related quality of life and functional mobility at five weeks after commencing their HEP compared with their baseline measures.

The study was registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12613000350729 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363922).

Section snippets

Design

A descriptive single group pilot study that provided a personalized DVD-HEP to older patients as part of their rehabilitation following a hip fracture. Pre-test – post-test measures were undertaken (each participant receiving intervention – each participant acting as their own control).

Participants and setting

A convenience sample of older adults who had fractured their hip at least 3 months prior to the study were recruited from the outpatient department at Swan Districts hospital in Western Australia. The aged care

Results

Recruitment took place between March and April 2013. As this was a feasibility project to test the approach of using a DVD to prescribe exercises, a convenience sample was recruited by the student from patients attending the outpatient clinic once weekly. Subsequently there were five older people approached of whom three women and one man consented for enrollment and all completed the five weeks of the study. Participants (mean age = 79.5, SD = 2.5 years) had fractured their hip between four

Discussion

This study sought to provide a tailored HEP for older people after hip fracture using a personalized DVD. Participants reported high levels of exercise adherence. These results were supported by participants making quantifiable physical improvements in functional strength and balance, which assist in performing daily living activities.19, 43 Participants also reported an improved sense of wellness and perceived that the DVD-HEP led to positive impacts in their lived experience.

The exercises

Conclusions

Providing a personalized DVD was a feasible means to prescribe a HEP and enhanced exercise adherence among older people with hip fracture. Participants responded positively to the DVD-HEP and demonstrated increased levels of self-efficacy for exercise. Researchers designing exercise programs for older people should consider evaluating if it is feasible to construct personalized DVD-HEPs in their own settings, to promote adherence to exercise. Further studies should also compare the effect on

Acknowledgments

The authors would like to thank Mr Warren Watts Senior Physiotherapist, the physiotherapy staff and day hospital staff at Swan Districts Hospital, Western Australia for their support and assistance in conducting the study. Dr Anne-Marie Hill is supported by a National Health and Medical Council of Australia early career research fellowship.

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