A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial.
Hip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of falling and associated activity restriction and thereby improves physical functioning.



This multicentre cluster randomised controlled trial will be conducted among older patients with hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive behavioural therapy, including guided exposure to feared activities (that are avoided by the participants). Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at 3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention will be evaluated. Primary outcome measures are fear of falling and mobility.



Targeted treatment of fear of falling may improve recovery and physical and social functioning after hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the intervention is feasible.



Netherlands Trial Register: NTR 5695 .
Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands. m.n.scheffers-barnhoorn@lumc.nl.
Maaike N
MN
Scheffers-Barnhoorn
Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Jolanda C M
JC
van Haastregt
Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Jos M G A
JM
Schols
Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Gertrudis I J M
GI
Kempen
Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.|Geriatric Center and Nursing Home Antonius Binnenweg, Laurens, Rotterdam, The Netherlands.
Romke
R
van Balen
Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
Jan H M
JH
Visschedijk
Department of Medical Decision Making and Quality of Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
Wilbert B
WB
van den Hout
Medical Psychology department, The Tjongerschans Hospital, Postbox 10500, 8440 MA, Heerenveen, The Netherlands.
Eve M
EM
Dumas
Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
Wilco P
WP
Achterberg
Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
Monica
M
van Eijk
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D005239:Fear; D005260:Female; D006620:Hip Fractures / Q000523:psychology* / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009426:Netherlands; D016896:Treatment Outcome
Cognitive behavioural therapy; Fear of falling; Geriatric rehabilitation; Hip fracture; Randomised controlled trial