None listed
Conditions
Brief summary
Hip fractures result in poor outcomes for older adults. Rehabilitation emphasises physical capacity and does not address lack of confidence. Motivational interviewing has a specific focus on increasing confidence for behaviour change. The primary aim is to determine if motivational interviewing increases walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. The secondary aims are to determine if motivational interviewing is a cost effective intervention that improves mobility-related function, physical activity, participation, and psychological outcomes, and reduces falls and hospital readmissions. In addition to receiving usual care, 270 people aged at least 65 years who have returned home after hip fracture will be randomly allocated to receive 10 telephone-based sessions of motivational interviewing to encourage walking or a control group receiving 10 telephone-based sessions of nutritional advice. Outcomes will be measured at 0, 9, 26, and 52 weeks. It is hypothesised that the motivational interviewing will be a cost effective intervention to help people return to living in the community after hip fracture.
Interventions
Name of intervention: Motivational interviewing
Who will deliver the intervention and what is their training: The intervention will be delivered by an allied health professional who has received training in motivational interviewing, through workshop attendance, on-line training, and one-on-one coaching from an expert motivational interviewing practitioner.
Mode of delivery: Telephone
Dose: There will be one session weekly for the first 8 weeks followed by two booster sessions, one at week-12
Name of intervention: Motivational interviewing Who will deliver the intervention and what is their training: The intervention will be delivered by an allied health professional who has received training in motivational interviewing, through workshop attendance, on-line training, and one-on-one coaching from an expert motivational interviewing practitioner. Mode of delivery: Telephone Dose: There will be one session weekly for the first 8 weeks followed by two booster sessions, one at week-12 and one at week-16. The duration of each session will be 30 minutes. Location/Timing: The intervention will be delivered when participants have been discharged home from hospital to enable the motivational interviewing discussions to be contextualised to daily life. Procedures and Personalisation: The content of each session with each individual will follow the recommended process of Engagement, Focusing, Evoking and Planning. Sessions 1-2 will focus on introduction and participant engagement while sessions 3-8 will focus on increasing confidence about walking. As a means of sustaining outcomes participants will also receive 2 booster sessions focusing on maintenance of confidence in walking behaviour in weeks 12 and 16. Fidelity: The allied health professional’s proficiency and fidelity in using motivational interviewing (intervention fidelity) will be confirmed through audio-recording of a small number of motivational interviewing sessions by an independent accredited assessor using the validated Motivational Interviewing Integrity scale.
Sponsors
La Trobe University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants will be included if they: • had a hip fracture (S72.0–S72.2 according to the International Classification of Diseases 10th revision (ICD-10)), • live at home independently, • are aged 65 years or older, • have been discharged from hospital within the last 6 months, • are able to walk independently with or without an assistive device • can communicate with conversational English, • and are insufficiently active (defined as obtaining less than 150 minutes of moderate intensity activity per week). The level of baseline physical activity will be screened using an accelerometer-based activity monitor over 7 days
Exclusion criteria
Participants will be excluded if they: • score in the severe range of depression or anxiety as measured by the Depression Anxiety and Stress Scale (DASS), because they would require high level psychological support, • score more than two errors on the 10-item Short Portable Mental Status Questionnaire indicative of impaired intellectual functioning, • are medically unstable to walk. Clinicians making the initial approach to potential participants will be informed of this eligibility criterion. On initial screen a member of the research team will ask: ‘Do you have any medical condition that would stop you from walking?’; ‘Do you ever have unexplained pains in your chest at rest or during walking?’; ‘Do you consistently feel faint or suffer from dizzy spells?’ (https://www.physicalactivityaustralia.org.au/wp-content/uploads/2016/09/Pre-Exercise-Screening-Form.pdf). If the participant answers yes to any of these questions the local doctor will be consulted before enrolment in the project. • are unable to converse over the telephone (for example, due to hearing loss) • live in residential care
Outcome results
None listed