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The Allied Health Clinical Research Office

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Improving walking after hip fracture

MIHip: Motivational Interviewing to Improve Walking After Hip Fracture

Hip fractures are a major public health issue affecting more than 23,000 Australians each year. They result in significant mortality and morbidity for older adults and are characterised by poor outcomes. One in five patients with hip fracture dies within 12 months, one in three patients do not return to living independently in the community, and one in two patients have markedly reduced levels of walking.

Patients with hip fracture are relatively inactive during rehabilitation and remain inactive after discharge home. Our work has shown that people recovering from a hip fracture do not lack the physical capacity to walk in their community, but rather lack the confidence to do so. Current rehabilitation protocols focus on the physical capacity to walk and do not address this issue.

Motivational interviewing is an intervention that has a specific focus on increasing confidence for behaviour change. In a pilot trial, we found eight weekly telephone sessions of motivational interviewing resulted in participants with hip fracture having an immediate increase in their walking and confidence about walking. The MIHip trial will determine if the positive results found in our pilot study are maintained in a  randomised attention placebo controlled trial of 270 participants with 12-month follow-up. We will also be conducting a full health economic analysis.

Patients receiving outpatient rehabilitation at Eastern Health and Peninsula Health following a hip fracture from September 2019 are being invited to participate in the trial, which is due to be completed in 2022. 


Physical activity after hip fracture

Outcomes after hip fracture are poor and physical activity levels are very low, but it is not known just how physically active people recovering from a hip fracture should be. In a project led by Nick Taylor, the physical activity of 60 people recovering from hip fracture in the community was closely monitored to determine the optimum level of physical activity associated with improved function.

Outcomes from this project have informed design of a randomised controlled trial. This trial will determine whether prescribing 100 min/week of physical activity in addition to usual care is a feasible and effective intervention for improving health outcomes in older adults following hip fracture.


Publications
  1. Taylor NF, et al. Community ambulation before and after hip fracture: a qualitative analysis. Disabil Rehabil 2010;32:1281-90. https://www.tandfonline.com/doi/abs/10.3109/09638280903483869
  2. Taylor NF, et al. Discharge planning for patients receiving rehabilitation after hip fracture. Disabil Rehabil 2010;32:492-9. https://www.tandfonline.com/doi/abs/10.3109/09638280903171568
  3. Peiris CL, Taylor NF, Shields N. Patients receiving inpatient rehabilitation do much less physical activity than recommended. J Physiother 2013;59:39-44. https://www.sciencedirect.com/science/article/pii/S1836955313701450
  4. Davenport SJ, Arnold M, Hua C, Schenk A, Batten, Taylor NF. Physical activity levels during acute inpatient admission after hip fracture are very low. Physiother Res Int 2015;20:174-81. https://onlinelibrary.wiley.com/doi/abs/10.1002/pri.1616
  5. Peiris CL, Shields N, Kingsley M, Yeung J, Hau R, Taylor NF. 2017. The maximum tolerated dose of walking for community-dwelling people recovering from hip fracture: a dose-response trial. Arch Phys Med Rehabil 98:2533-39. https://www.sciencedirect.com/science/article/pii/S0003999317302617
  6. O’Halloran P, Blackstock F, Shields N, Taylor NF et al. Motivational interviewing to increase physical activity: a systematic review. Clin Rehabil 2014; 28:1159-71. https://journals.sagepub.com/doi/abs/10.1177/0269215514536210
  7. O'Halloran PD, Shields N, Blackstock F, Taylor NF et al. Motivational interviewing increases physical activity and self-efficacy after hip fracture. Clin Rehabil 2016;30:1108-1119. https://journals.sagepub.com/doi/abs/10.1177/0269215517741665