The Status And Influencing Factors Of Fear Of Falling In Elderly Patients With Hip Fracture During Early Postoperative Rehabilitation Stage

ObjectiveTo understand the experience of fear of falling(FOF)and the expectation of rehabilitation in the early rehabilitation stage of elderly patients with hip fracture(HF)through qualitative interviews.Based on the scoping review,combined with the experience of clinical experts and the experience related to the causes of FOF,the quantitative research indicators were developed,and prospective observational studies were conducted to further analyze the status and influencing factors of FOF.The prediction models were constructed from early postoperative hospitalization to home rehabilitation stage,so as to predict FOF at different stages and the formulate intervention measures.Methods1.Qualitative interview on postoperative FOF experience and expectation of elderly patients with HF during early rehabilitation stageThe elderly HF patients hospitalized in the Department of Orthopaedics,Affiliated Hospital of Jiangnan University from May to October 2021 were selected by objective sampling for semi-structured interviews through descriptive phenomenological research methods.The Colaizzi-7-step analysis method was used for data analysis and topic extraction.2.Research indexes for the analysis of influencing factors of early postoperative FOF in elderly patients with HFUnder the guidance of the scoping review methodology framework and methodology manual,the scope of the influencing factors of postoperative FOF was reviewed.The main contents include clarifying research questions,develop a literature search strategy,literature screening evaluation and collation and data extraction.At the same time,research indexes were developed based on clinical experts’experience and qualitative interview results related to the causes of FOF..3.The status and influencing factors of FOF in elderly patients with HF during early postoperative rehabilitation stageThis prospective observational study was used to select elderly patients who were admitted to hospital for HF and underwent surgical treatment from May 2021 to October 2022.The research tools include the general information questionnaire,Chinese version of the Falls Efficacy Scale-International(FES-I),Numerical Rating Scale(NRS),Hamilton depression scale-17(HAMD-17),Hamilton anxiety scale-14(HAMA-14),Harris Hip score(HHS),Berg balance scale(BBS),Post-traumatic stress disorder Checklist-Civilian version(PCL-C).The early postoperative hospitalization stage was 3 days after surgery.The single-item question"Are you afraid of fall during postoperative exercise?"was used to further analyze the influencing factors of fear of falling according to the results of answering"yes"or"no."Taking the research index as the independent variable and the outcome index as the dependent variable,the single factor analysis,multiple regression analysis,ROC curve analysis and prediction models were carried out in turn to explore the influencing factors of FOF in the early hospitalization stage of elderly patients with postoperation HF.The postoperative home rehabilitation stage was 3 months after surgery.Not only a single item questionnaire was used,but also the degree of FOF was quantified by the Chinese version of the falls efficacy scale-international.The degree of FOF was taken as the dependent variable,and the research index was taken as the independent variable.Single factor analysis,correlation analysis and multiple linear regression model were carried out to explore the influencing factors of FOF in the early home rehabilitation stage of elderly patients with HF after surgery.Results1.Qualitative interview on postoperative FOF experience and expectation of elderly patients with HF during early rehabilitation stageFour themes and twelve sub-themes were summarised:FOF causes trouble in daily life(limited daily activities,environmental sensitivity,negative emotional interference);cognitive experience of FOF(reduced self-efficacy,worry about unknown events,lack of security);behavioral experience of FOF(avoidance of movement,self-pressure,reduced social interaction);home-based rehabilitation needs(craving for caregiver support,demand for continuous rehabilitation guidance and care,craving for support from primary medical institutions).2.Research indexes for the analysis of influencing factors of FOF in elderly patients with HF during early rehabilitation stageA total of 379 literatures were initially examined,and 21 original studies were finally included for systematic review.Based on the bio-psycho-social medical model,the indexes for further research are finally summarized from these aspects:socio-demographic data,physiological condition and psychological status and surgery-related data by referring to the experience of clinical experts and qualitative interview results.3.The status and influencing factors of FOF in elderly patients with HF during early postoperative rehabilitation stage3.1 The status of FOF during early postoperative rehabilitation stage of elderly patients with HFAmong the 266 elderly patients with HF,there were 175 cases of FOF 3 days after surgery,accounting for 65.8%.There were 134 cases of FOF 3 months after surgery,accounting for 50.4%,and persistent FOF accounted for 41.4%.3.2 Influencing factors of FOF during early postoperative hospitalization stage3.2.1 Univariate analysis showed that there were statistically significant differences in gender,age,education level,hypertension,number of chronic diseases,multiple medications,fracture site,surgical method,history of falls within 1 year,medical insurance type,main economic source,preoperative malnutrition(serum albumin content),serum calcium content,HAMA-14,HAMD-17 and NRS between groups(p<0.05).3.2.2 Binary Logistic regression analysis showed that age(OR=1.175,p<0.001),surgical approach(incision reposition and internal fixation-total hip replacement)(OR=0.093,p=0.002),number of chronic diseases(combined with 1～2 chronic diseases-no chronic diseases)(OR=4.861,p<0.001),number of chronic diseases(combined with 3～4 chronic diseases-no chronic diseases)(OR=5.836,p=0.016),preoperative malnutrition(Yes-No)(R=9.053,p<0.001),HAMA score(OR=1.266,p=0.001)and NRS(OR=3.258,p<0.001)were the influencing factors of postoperative FOF during early postoperative hospitalization stage.3.2.3 ROC curve analysis【P=1/{1+exp[-(0.161×Age-2.373×Open reduction internal fixation+1.581(1～2 Chronic diseases)+1.764×(3～4 Chronic diseases)+2.203×Properative malnutrition+0.235×HAMA score+1.181×NRS-19.712)]}】showed that the accuracy of the model was 88.7%,the sensitivity was 81.3%,the specificity was92.6%,the area under the ROC curve was 0.945,and the correct rate of FOF was 92.6%.The model has a good judgment effect.3.3 Influencing factors of FOF during early postoperative home rehabilitation stage3.3.1 The results of univariate analysis and correlation analysis showed that age(r=0.351,p<0.001),gender(t=-2.103,p=0.036),surgical approach(F=13.898,p<0.001),number of chronic diseases(r_s=0.226,p<0.001),medical insurance category(F=3.649,p=0.033),home caregiver(F=3.138,p=0.045),family and social support(r_s=-0.146,p=0.017),HAMA score(r=0.559,p<0.00),HAMD score(r=0.624,p<0.001),PCL-C score(r=0.495,p<0.001),BBS(r=-0.281,p<0.001)and HHS(r=-0.444,p<0.001)were statistically significant.It was found that the correlation between the single item questionnaire and the FES-I score was0.827,and the two were highly correlated.3.3.2 The results of multicollinearity regression analysis【FES-I score=11.027+2.396×(3～4 Chronic diseases)+7.752×(≥5 Chronic diseases)+0.161×PCL-C score+0.221×BBS-0.304×HHS+0.155×Age+0.597×HAMA+0.866×HAMD】showed that age,number of chronic diseases,HAMA,HAMD,PCL-C,BBS and HHS were the influencing factors of postoperative FOF(p<0.05).For different dimensions of FOF,the influencing factors are slightly different.age,gender,HAMA,HAMD,HHS and BBS were the influencing factors of the indoor dimension of FOF(p<0.05).The number of chronic diseases,HAMA,HAMD,HHS,BBS and PCL-C were the influencing factors of the outdoor dimension of FOF(p<0.05).HAMA,HAMD,HHS and BBS can affect the FOF in indoor and outdoor dimensions,among which HHS and BBS are protective factors and the rest are risk factors.The regression equation can explain 57.5%of the variation of the dependent variable.ConclusionThe fear of falling in the early rehabilitation stage of elderly patients with hip fracture is mainly manifested in the distress in daily life,cognition and behavioral experience of FOF and the demand for home rehabilitation.The incidence of postoperative FOF in elderly patients with HF is high and lasts for a long time,which seriously affects the enthusiasm of postoperative rehabilitation exercise.Elderly patients with chronic diseases are at high risk of postoperative FOF.In clinical work,it is necessary to improve preoperative examination,implement chronic disease management work,dynamic nutritional assessment,continuous attention to postoperative negative emotions,such as anxiety,depression,traumatic stress disorder,and precise intervention to prevent the occurrence of FOF.The prediction model of FOF at different stages in the early postoperative period preliminarily constructed in this study is convenient for clinical practice to identify high-risk groups and achieve accurate prevention and intervention.In the implementation of continuous nursing,it is necessary to strengthen the interaction between medical staff and patients,and continuously pay attention to the recovery of balance ability and hip function in patients’home rehabilitation stage.The medical staff can also implement remote guidance according to the actual situation,teach patients and their families to make’Internet+’service appointments,and enjoy face-to-face and hand-to-hand rehabilitation exercise guidance to improve the quality of life of patients after surgery.