Date Presented 04/05/19
This is a prospective cohort study with 55 participants, mean age 80.82 (SD = 5.69). The aim was to examine the relationships between positive psychological factors of positive affect, optimism, and hope and physical factors six months after rehabilitation, and functional ability and participation among elderly with hip fracture. The current findings showed that optimism and hand grip strength predicted functional ability. Hope total score predicted participation in daily life situation.
Primary Author and Speaker: Orit Segev-Jacubovski
Contributing Authors: Adina Maeir, Hagit Magen
BACKGROUND: Hip fractures, particularly in elderly, result in loss of independence in ambulation, limits in activities of daily living (ADL) and instrumental ADL (IADL), reduced quality of life and restrictions in participation in daily life situations even one year following the fracture (Dyer et al., 2016; Magaziner et al., 2000). In recent years, there has been an advance in investigating the role of positive psychological factors among rehabilitation populations due to a variety of physical injuries, however, the results are inconclusive (Fredman, Hawkes, Black, Bertrand, & Magaziner, 2006; Kortte, Stevenson, Hosey, Castillo, & Wegener, 2012).
OBJECTIVE: to examine the relationships between positive psychological factors of positive affect, optimism and hope, and functional ability and participation among older adults with hip fracture, six months after discharge from rehabilitation. In addition, to examine the extent to which positive psychological and physical factors are predictive of functional ability and participation.
DESIGN: This is an observational prospective cohort study. The participants sustained a hip fracture due to a fall and were initially referred to a university-affiliated major post-acute geriatric rehabilitation center. Data collection took place six months post the rehabilitation period, during visits to the participants homes.
PARTICIPANTS: Fifty-five participants with a mean age of 80.82 (SD = 5.69), who sustained a fall-related hip fracture. The inclusion criteria were: 65 years and older, were able to independently leave their home before the fall, Mini Mental State Examination score 24 or above at admission and agreed to participate by signing informed consent. Exclusion criterion were: participants with neurological impairments, admitted from a nursing home, had multiple fractures, pathologic fracture, history of metastatic cancer, were unable to walk before the fracture, non-weight baring post-surgery, or suffering from other medical complications during rehabilitation.
METHODS: Participants completed three questionnaires: Adult Hope Scale, Life Orientation Test and Positive Affect questionnaire. Additionally, hand grip strength and pain were used as estimates of general physical condition. Rehabilitation outcomes were the Functional Independence Measure Motor Scale (mFIM), measuring functional ability, and the Activity Card Sort (ACS) measuring participation.
ANALYTICAL METHODS: Pearson correlation coefficients were used to test the correlations between positive psychological, physical factors and rehabilitation measures. Two stepwise linear regressions were computed to determine which variables predicted functional ability and participation.
RESULTS: Functional ability was significantly correlated with positive affect, optimism, the hope-pathways component, hope total score and hand grip strength. Participation was significantly correlated with optimism, the hope-agency, hope-pathways components and hope total score. Stepwise linear regression for the mFIM revealed that optimism accounted for 15% of the variance and that hand grip strength accounted for additional 9.4% of the variance. The ACS was significantly predicted only by the hope total score, which accounted for 11% of the variance.
CONCLUSION: The current findings provide evidence that optimism and hope six months after acute rehabilitation play a role in functional ability and participation at that time point. Hence, the evaluation of positive psychological factors is important for understanding the rehabilitation outcomes. In addition, long-term rehabilitation intervention should aim at bolstering optimism and hope as a powerful method of channeling patients' psychological resources that could influence their functional recovery.
References
Dyer, S. M., Crotty, M., Fairhall, N., Magaziner, J., Beaupre, L. A., Cameron, I. D., & Sherrington, C. (2016). A critical review of the long-term disability outcomes following hip fracture. BMC Geriatrics, 16, 158. https://doi.org/10.1186/s12877-016-0332-0
Fredman, L., Hawkes, W. G., Black, S., Bertrand, R. M., & Magaziner, J. (2006). Elderly patients with hip fracture with positive affect have better functional recovery over 2 years. Journal of the American Geriatrics Society, 54(7), 1074–1081. https://doi.org/10.1111/j.1532-5415.2006.00786.x
Kortte, K. B., Stevenson, J. E., Hosey, M. M., Castillo, R., & Wegener, S. T. (2012). Hope predicts positive functional role outcomes in acute rehabilitation populations. Rehabilitation Psychology, 57(3), 248–255. https://doi.org/10.1037/a0029004
Magaziner, J., Hawkes, W., Hebel, J. R., Zimmerman, S. I., Fox, K. M., Dolan, M., … Kenzora, J. (2000). Recovery From Hip Fracture in Eight Areas of Function. Journal of Gerontology, 55(9), M498–M507. https://doi.org/10.1093/gerona/55.9.M498
