Physical function and fear of falling after hip fracture rehabilitation inthe elderly

Objective: The purpose of this study was to determine the relationship betw een physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program. Design: We used a prospective cohort study over 12 mo to determine the effe ct of a specialized hip fracture rehabilitation program in a geriatric hosp ital on physical function and fear of falling. Fifty-six patients were admi tted consecutively from acute care. Physical function was assessed using th e Functional independence Measure, and fall-related self-efficacy was measu red using two scales: the Falls-Efficacy scale and the Activities-Specific Balance Confidence scale. We also used the Vitality scale to measure qualit y of life. All measures, represented by change scores, were determined at t he beginning and end of the patients' rehabilitation programs. Results: Significant improvement in physical function and fall self-efficac y was observed. The Vitality scale was also improved after rehabilitation. The Falls-Efficacy scale appeared to be more sensitive to change than the A ctivities-Specific Balance Confidence scale, whereas no correlation was fou nd between changes in the fall-related self-efficacy measures and the Funct ional Independence Measure. Conclusions: These findings may represent a discrepancy between attention o f the rehabilitation program on functional outcomes and less emphasis on co nfidence building behaviors. Restrictions in function from a fear of fallin g may negate any gains made through rehabilitation, and this could limit th e long-term success of these programs and patient outcomes after hip fractu re.