title: Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial.
abstract: OBJECTIVE
  To examine whether self-efficacy mediated the effect of the Home-based Post-Hip Fracture Rehabilitation program on activity limitations in older adults after hip fracture and whether the mediating effect was different between sex and age groups.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Community.
  
  
  METHODS
  Participants with hip fracture (N=232; mean age ± SD, 79±9.4y) were randomly assigned to intervention (n=120, 51.7%) and attention control (n=112, 48.3%) groups.
  
  
  METHODS
  The 6-month intervention, the Home-based Post-Hip Fracture Rehabilitation, is a functionally oriented, home-based exercise program. Data were collected at baseline, postintervention (6mo), and follow-up (9mo).
  
  
  METHODS
  Activity Measure for Post-Acute Care.
  
  
  RESULTS
  The mediating effect of the Home-based Post-Hip Fracture Rehabilitation program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (βindirect=.21). Similarly, the mediating effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (βindirect=.49). In subgroup analyses, the mediating effect was significant at 9 months in the younger group (age, ≤79y) in comparison to the older group and was significant in women in comparison to men.
  
  
  CONCLUSIONS
  Self-efficacy may play a partial mediating role in the effect on some longer-term functional outcomes in the Home-based Post-Hip Fracture Rehabilitation intervention. The results suggest that program components that target self-efficacy should be incorporated in future hip fracture rehabilitation interventions. Age and sex of the targeted participants may also need to be considered when developing interventions.
authors.affiliation: Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Health and Disability Research Institute, Boston University School of Public Health, Boston, MA. Electronic address: fhchang@bu.edu.
authors.forename: Feng-Hang
authors.initials: FH
authors.lastname: Chang
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Latham
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA.
authors.forename: Pengsheng
authors.initials: P
authors.lastname: Ni
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jette
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D020377:Self Efficacy; D012737:Sex Factors
keywords: Activities of daily living; Aging; Hip fractures; Mobility limitation; Rehabilitation; Self-efficacy