Feature ArticleUsing a personalized DVD to prescribe an exercise program to older people post-hip fracture enhances adherence to the exercises – A feasibility study
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.
References (45)
- et al.
Maximising functional recovery following hip fracture in frail seniors
Best Pract Res Clin Rheumatol
(2013) - et al.
Factors associated with older patients' engagement in exercise after hospital discharge
Arch Phys Med Rehabil
(2011) - et al.
Adherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics
Prev Med
(2012) - et al.
Challenges in tailored intervention research
Nurs Outlook
(2010) - et al.
Computer-tailored health interventions delivered over the Web: review and analysis of key components
Patient Educ Couns
(2009) - et al.
“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975) - et al.
A systematic review of hip fracture incidence and probability of fracture worldwide
Osteoporos Int
(2012) - et al.
An estimate of the worldwide prevalence and disability associated with osteoporotic fractures
Osteoporos Int
(2006) - et al.
Meta-analysis: excess mortality after hip fracture among older women and men
Ann Intern Med
(2010) - et al.
Hip fracture
BMJ
(2006)
Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged
Am J Epidemiol
Mortality and morbidity after hip fractures
BMJ
Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial
Arch Intern Med
Interventions for improving mobility after hip fracture surgery in adults
Cochrane Database Syst Rev
The Exercise Plus Program for older women post hip fracture: participant perspectives
Gerontologist
Exercise adherence following physical therapy intervention in older adults with impaired balance
Phys Ther
Attrition and adherence rates of sustained vs. intermittent exercise interventions
Ann Behav Med
Psychosocial issues in engaging older people with physical activity interventions for the prevention of falls
Can J Aging
Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review
Age Ageing
Falls after discharge from hospital: is there a gap between older peoples' knowledge about falls prevention strategies and the research evidence?
Gerontologist
A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions
Ageing Soc
Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?
Phys Ther
Cited by (8)
Community rehabilitation interventions after hip fracture: Pragmatic evidence-based practice recommendations
2019, International Journal of Orthopaedic and Trauma NursingCitation Excerpt :A telerehabilitation programme, based on video clips of rehabilitation exercises (as complementary treatment to standard physiotherapy), led to greater improvements in the Two-Minute Walk Test and walking speed than in the control group (Kalron et al., 2018). Watching a Digital Video Disc (DVD) with individualised home exercises led to increased levels of adherence and self-efficacy for exercise (Moran et al., 2015). An 8-week programme of motivational interviewing by telephone as an addition to a community rehabilitation programme (of either home- or centre-based therapy in an interdisciplinary setting) led to significantly more steps per day, longer walking periods, improved self-efficacy about walking, better HRQoL, and improved mental health (O'Halloran et al., 2016).
Rehabilitation for Frail Patients With Hip Fracture
2023, Topics in Geriatric RehabilitationFunctional recovery after hip fracture
2022, Senior Trauma Patients: An Integrated Approach