Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people.
BACKGROUND
Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account.


METHODS
Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong-Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL).


RESULTS
Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant.


CONCLUSIONS
Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.
Oude Voshaar
Richard C
RC
Radboud University Nijmegen Medical Centre, The Netherlands.
Banerjee
Sube
S
Horan
Mike
M
Baldwin
Robert
R
Pendleton
Neil
N
Proctor
Rebekah
R
Tarrier
Nicholas
N
Woodward
Yvonne
Y
Burns
Alistair
A
D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003289:Convalescence / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy; D004739:England; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D010555:Personality Inventory; D011183:Postoperative Complications / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D018434:Sickness Impact Profile
D000928:Antidepressive Agents