None listed
Conditions
Brief summary
Older adults admitted for acute care are extremely sedentary, more so for post-hip fracture patients. With the relationship between sedentary behaviour (SB) and poor outcomes, various interventions to reduce SB and increase physical activity (PA) is critical if older adults are to achieve some level of pre-fracture status post-hip fracture across all continuum of care. However, so far, it is not clear if providing coaching and real-time feedback to patients on their level of SB and PA will encourage them to take more action to reduce SB and increase PA during acute care and afterwards. Therefore, an individualised goal-setting intervention to break SB and increase PA while on admission in acute care post-hip fracture is important. This study will utilise health coaching and ActiGraph-based real-time feedback to break SB and increase PA while on admission and follow-up at 3, 6 and 12 weeks respectively to determine the effect of an intervention on SB, PA and other geriatric-specific outcomes in the long-term. Study Hypothesis: There will be no significant difference between intervention and control groups on sedentary behaviour and physical activity measures
Interventions
1. Objective real-time feedback with ActiGraph
All participants will wear an ActiGraph GT9X (ActiGraph LLC, Pensacola, FL, USA) on their non-dominant wrist from day 3 post-operatively, even though research has shown that wearing it on the wrist and ankle has lower validity than wearing it on the waist. However, participants may not feel comfortable wearing it on the waist immediately after surgery. In addition, we chose the wrist because participants, clinical staff and carers will be required t
1. Objective real-time feedback with ActiGraph All participants will wear an ActiGraph GT9X (ActiGraph LLC, Pensacola, FL, USA) on their non-dominant wrist from day 3 post-operatively, even though research has shown that wearing it on the wrist and ankle has lower validity than wearing it on the waist. However, participants may not feel comfortable wearing it on the waist immediately after surgery. In addition, we chose the wrist because participants, clinical staff and carers will be required to read off real-time feedback on activity level. For this study, the GT9X device will be programmed to record accelerations in 1-sec (sec) epochs with low-frequency extension in order to increase its sensitivity to capture low-intensity movements. The ActiGraph GT9X was chosen for its ability to provide real-time activity feedback on the number of steps a participant has taken over a given period as well as energy expenditure. Participants will be asked to wear the device for 24 hours for 10 days or before discharge, whichever comes first. Adherence to the trial will be measured by wear adherence (explored using GT9X analytics), missing data and participation in activities prescribed by the physiotherapists (physiotherapists will record exercise administered, intensity and duration on an excel sheet) SMART Goal setting Physiotherapists will guide participants to set daily SMART goals on improving step counts, increase the number of sedentary breaks and increase the time spent standing or stepping. SMART goals involve participants setting activity goals (e.g. number of steps, number of transitions, reps of weight-bearing exercises) with the physiotherapist daily or twice daily and working to achieve these goals with the physiotherapist, personally and other members of the health team. Goals are set during one-on-one sessions with the physiotherapist in the hospital. The goals, as well as the frequency and duration of each session, will depend on the participant’s ability and physiotherapist’s assessment. On weekdays, if a participant meets goals in the morning, the goals will be reviewed during the afternoon physiotherapy session. The physiotherapist will set weekend goals for the participants on Friday and it is to be noted that on weekends, physiotherapy input is limited to once daily visits. It should also be noted that there will no goal-setting over the weekend and there will be no coaching given the weekend rostering arrangements. Adherence will be measured by participation in activities prescribed by the physiotherapists (physiotherapists will record exercise administered, intensity and duration on an excel sheet) Coaching The participants will be coached one-on-one by the physiotherapist in hospital on weekdays about the deleterious effects of sedentary behaviour (SB) on outcomes for older adults following hip fracture surgery in the hospital and afterwards. Coaching sessions are expected to last for less than 10 minutes. The advantages of breaking sedentary time incrementally will be taught verbally and barriers to doing this will also be discussed. Based on their responses, the perceived barriers to achieving their objective will be discussed and addressed. Participants will also be offered the opportunity to view their X-rays by the Physiotherapist as a way of allaying their fear of re-fracture. Coaching sessions will last for 10 minutes twice daily for the duration of patient stay in hospital Intervention is expected to last for 6 months. Participants in the intervention group will receive usual care in addition to intervention
Sponsors
University of Adelaide
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
i. aged 65 years and above; ii. admitted to the orthopaedic ward; iii. able to converse in English; iv. mobilising independently (with or without a walking aid) prior to admission; v. living at home or independent living unit prior to hospitalisation; vi. able to commence the study within 72 hours of admission.
Exclusion criteria
i. they are admitted from a nursing home, skilled nursing facility (e.g. Sutherland Court) or hospital; ii. deemed too unwell to participate by the orthogeriatrician (or registrar); iii. deemed to require palliation by the orthogeriatrician (or registrar); iv. deemed unable to provide informed consent by the orthogeriatrician (or registrar). v. they have footdrop following surgery
Outcome results
None listed