title: Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial Testing the effectiveness of the exercise plus program in older women post-hip fracture The long-term effect of being treated in a geriatric ward compared to an orthopaedic ward on six measures of free-living physical behavior 4 and 12 months after a hip fracture - a randomised controlled trial Accuracy of step count measured by physical activity monitors: The effect of gait speed and anatomical placement site. Recovery from hip fracture in eight areas of function. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials How many hours are enough? Accelerometer wear time may provide bias in daily activity estimates. Quantification of Outdoor Mobility by Use of Accelerometer-Measured Physical Behaviour Physical behavior and function early after hip fracture surgery in patients receiving comprehensive geriatric care or orthopedic care--a randomized controlled trial. Sedentary Behavior and Physical Function Decline in Older Women: Findings from the Women's Health Initiative Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit The nuts and bolts of PROSPERO: an international prospective register of systematic reviews HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial. Walking tolerance of patients recovering from hip fracture: a phase I trial Patients receiving inpatient rehabilitation for lower limb orthopaedic conditions do much less physical activity than recommended in guidelines for healthy older adults: an observational study.
abstract: Objective : To investigate if motivational interviewing improved physical activity , self-efficacy , quality of life , mobility and mental health in people living in the community after hip fracture . Design : Single-blind r and omized controlled trial . Setting : Community . Participants : A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14 ) or an intervention group ( n = 16 ) . Intervention : All participants received usual care . The intervention group also received eight weekly sessions of motivational interviewing as additional input , with the control group having no additional matching input . Main outcomes : The primary outcome was physical activity levels as measured by an accelerometer ( steps taken per day , time spent walking per day , and time spent sitting or lying each day ) . Secondary outcomes included self-efficacy ( confidence about walking and not falling ) , health-related quality of life , mobility and mental health . Results : Relative to usual care , the motivational interviewing group took significantly more steps per day ( mean = 1237 steps , 95 % confidence interval ( CI ) 12 to 2463 ) , walked for longer per day ( mean = 14.4 minutes , 95 % CI 0.6 to 28.8 ) , had improved self-efficacy evidence d by being more confident about walking ( mean = 1.6 units out of 10 , 95 % CI 0.3 to 2.9 ) and not falling ( mean = 1.1 units out of 10 , 95 % CI 0.3 to 1.9 ) and improved health-related quality of life and mental health . Conclusion : This study provides preliminary evidence that motivational interviewing can result in clinical ly meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture Background : Exercise is an important strategy with potential to improve recovery in older adults following a hip fracture . Purpose : The purpose of this study was to test the impact of a self-efficacy based intervention , the Exercise Plus Program , and the different components of the intervention , on self-efficacy , outcome expectations , and exercise behavior among older women post-hip fracture . Methods : Participants were r and omized to one of four groups : exercise plus , exercise only , plus only ( i.e. , motivation ) , or routine care . Data collection was done at baseline ( within 22 days of fracture ) , 2 , 6 , and 12 months post-hip fracture . Results : A total of 209 women were recruited with an average age of 81.0 years ( SD=6.9 ) . The majority was White ( 97.1 % ) , was widowed ( 57.2 % ) , and had a high school education ( 66.7 % ) . Generalized Estimating Equations were used to perform repeated measures analyses . No differences in trajectories of recovery were observed for self-efficacy or outcome expectations . A statistically significant difference in the overall trajectory of time in exercise was seen ( p<.001 ) , with more time spent exercising in all three treatment groups . Conclusions : The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only , exercise only , and the exercise plus groups all increased exercise Background This study is part of the Trondheim Hip Fracture Trial , where we compared free-living physical behavior in daily life 4 and 12 months following  hip surgery  for patients managed with comprehensive geriatric care ( CGC ) in a geriatric ward with those managed with orthopedic care ( OC )  in an orthopedic ward . Methods This is a single centre , prospect i ve , r and omized controlled trial . 397 hip fracture patients were r and omized to CGC ( n = 199 ) or OC ( n = 198 ) in the Emergency Department with follow-up assessment s performed four and 12 months post-surgery . Outcomes were mean upright time , number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor . Missing data were h and led by multiple imputation and group differences assessed by linear regression with adjustments for gender , age and fracture type . Results There were no group differences in participants ’ pre-fracture characteristics . Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min ( 17.4 % , CI 9.6 to 59.6 , p = .007 ) and at 12 months , 27.7 min ( 13.9 % , CI 3.5 to 51.8 , p = .025 ) . Average and maximum length of upright events was longer in the CGC ( p ’s < .042 ) . No group difference was found for number of upright events ( p ’s > .452 ) . Conclusion Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery , with more time and longer periods spent in upright . Results support findings from the same study for functional outcomes , and demonstrate that CGC impacts daily life as long as one year after surgery . Trials registration Clinical Trials.gov , NCT00667914 , April 18 , INTRODUCTION Consumer-based physical activity monitors ( PAMs ) are becoming increasingly popular , with multiple global organisations recommending physical activity levels that equate to 10,000 steps per day for optimal health . We therefore aim ed to compare the step count of five PAMs to a visual step count to identify the most accurate monitors at varying gait speeds , along with the optimal anatomical placement site . METHODS Participants completed 3min on a treadmill for five speeds ( 5.0 km/h , 6.5 km/h , 8.0 km/h , 10 km/h , 12 km/h ) . An Actigraph wGT3XBT-BT was placed on the waist and wrist , a FitBit One on the waist , and a Fitbit Flex , Fitbit Charge HR and Jawbone UP24 on both wrists . A video of participant 's lower limbs was recorded for visual count . Analyses of variance ( ANOVAs ) were conducted to examine the effects of gait speed and device placement site on step count accuracy . RESULTS Thirty-one participants ( mean age 24.3±5.2yrs ) took part . Step count error ranged from 41.3±13.8 % for the wrist-worn Actigraph to only 0.04±4.3 % and -0.3±4.0 % for the waist-worn Fitbit One and Actigraph , respectively . Across all gait speeds , waist-worn devices achieved better accuracy than those on the wrist ( p<0.001 ) . The Jawbone was the most accurate wrist-worn consumer-based device at slower speeds ( p=0.026 ) , with the Fitbit Flex , and Fitbit Charge HR increasing in accuracy to match the Jawbone at higher speeds . CONCLUSION The accuracy and reliability of consumer-based PAMs and the Actigraph is affected by anatomical placement site and walking speed . The Fitbit One and Actigraph on the waist were the strongest performers across all speeds BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND There is little consensus on how many hours of accelerometer wear time is needed to reflect a usual day . This study identifies the bias in daily physical activity ( PA ) estimates caused by accelerometer wear time . METHODS 124 adults ( age = 41 ± 11 years ; BMI = 27 ± 7 kg·m⁻² ) contributed approximately 1,200 days accelerometer wear time .  Five 40 day sample s were r and omly selected with 10 , 11 , 12 , 13 , and 14 h·d⁻¹ of wear time . Four semisimulation data sets ( 10 , 11 , 12 , 13 h·d⁻¹ ) were created from the reference 14 h·d⁻¹ data set to assess Absolute Percent Error ( APE ) . Repeated- measures ANOVAs compared min·d⁻¹ between 10 , 11 , 12 , 13 h·d⁻¹ and the reference 14 h·d⁻¹ for inactivity ( < 100 cts·min⁻¹ ) , light ( 100 - 1951 cts·min⁻¹ ) , moderate ( 1952 - 5724 cts·min⁻¹ ) , and vigorous ( ≥5725 cts·min⁻¹ ) PA . RESULTS APE ranged from 5.6%-41.6 % ( 10 h·d⁻¹ = 28.2%-41.6 % ; 11 h·d⁻¹ = 20.3%-36.0 % ; 12 h·d⁻¹ = 13.5%-14.3 % ; 13 h·d⁻¹ = 5.6%-7.8 % ) . Min·d⁻¹ differences were observed for inactivity , light , and moderate PA between 10 , 11 , 12 , and 13 h·d⁻¹ and the reference ( P < .05 ) . CONCLUSIONS This suggests a minimum accelerometer wear time of 13 h·d⁻¹ is needed to provide a valid measure of daily PA when 14 h·d⁻¹ is used as a reference Hip fractures in older persons are associated with both low levels of daily physical activity and loss of outdoor mobility . The aim was to investigate if accelerometer-based measures of physical behaviour can be used to determine if people undertake outdoor walking and to provide reference values for physical behaviour outcomes related to outdoor mobility . Older persons ( n = 245 ) , ≥70 years , one year after hip fracture , participated .  Six objective measures of physical behaviour collected by an activity monitor were compared with self-reported outdoor mobility assessed with the Nottingham Extended ADL scale . All measures of time and length in upright periods were significantly lower in participants who reported not walking outdoors ( p < 0.001 ) . A set of cut-off points for the different physical behaviour variables was generated . Maximum length of upright events discriminated best between groups , with 31 minutes as a threshold to determine if a person is more likely to report that they walk outdoors ( sensitivity : 0.805 , specificity : 0.704 , and AUC : 0.871 ) or 41 minutes or more to determine if a person is more likely to report outdoor walking on their own ( AUC : 0.891 ) . Physical behaviour  variables from activity monitoring can provide information about patterns of physical behaviour related to outdoor activity performance BACKGROUND This study is a part of the r and omized controlled trial , the Trondheim Hip Fracture Trial , and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care ( CGC ) with those managed with orthopedic care ( OC ) .  METHODS Treatment comprised CGC with particular focus on mobilization , or OC .  A total of 397 hip fracture patients , age 70 years or older , home dwelling , and able to walk 10 m before the fracture , were included . Primary outcome was measurement of upright time ( st and ing and walking ) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor . Secondary outcomes were number of upright events on Day 4 , need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1 - 3 , and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery . RESULTS A total of 317 ( CGC n = 175 , OC n = 142 ) participants wore the activity monitor for a 24-hour period . CGC participants had significantly more upright time ( mean 57.6 vs 45.1 min , p = .016 ) , higher number of upright events ( p = .005 ) and better Short Physical Performance Battery scores ( p = .002 ) , than the OC participants . Cumulated Ambulation score did not differ between groups ( p = .234 ) . CONCLUSIONS When treated with CGC , compared with OC , older persons suffering a hip fracture spent more time in upright , had more upright events , and had better lower limb function early after surgery despite no difference in their need for assistance during ambulation Sedentary behavior is associated with deleterious health outcomes . This study evaluated the association between sedentary time and physical function  among postmenopausal women in the Women 's Health Initiative Observational Study . Data for this prospect i ve cohort study were collected between 1993–1998 ( enrollment ) and 2009 , with an average of 12.3 follow-up years . Analyses included 61,609 women ( aged 50–79 years at baseline ) .  Sedentary time  was estimated by question naire ; physical function was measured using the R AND SF-36 physical function scale . Mixed-model analysis of repeated measures was used to estimate the relationship of  sedentary time  exposures and changes in physical function adjusting for relevant covariates . Compared to women reporting sedentary time of ≤6 hours/day , those with greater amounts of sedentary time ( > 6–8 hours/day , > 8–11 hours/day , > 11 hours/day ) reported lower physical function between baseline and follow up ( coefficient = −0.78 , CI = −0.98 , −0.57 , −1.48 , CI = −1.71 , −1.25 , −3.13 , and CI = −3.36 , −2.89 , respectively P < 0.001 ) . Sedentary time  was strongly associated with diminished physical function and most pronounced among older women and those reporting the greatest sedentary time . Maintaining physical function with age may be improved by pairing messages to limit sedentary activities with those promoting recommended levels of physical activity Background . Comprehensive stroke unit care , incorporating acute care and rehabilitation , may promote early physical activity after stroke . However , previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit . This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit . Methods . This study was a prospect i ve observational study . Behavioural mapping was used to determine the proportion of the day spent in different activities . Therapist reports were used to determine the amount of  formal therapy  received on the day of observation . The timing of commencement of activity out of bed was obtained from the medical records . Results . On average , patients spent 45 % ( SD 25 ) of the day in some form of physical activity  and received 58 ( SD 34 ) minutes per day of  physiotherapy and occupational therapy combined . Mean time to first mobilisation out of bed was 46 ( SD 32 ) hours post-stroke . Conclusions . This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit , when compared to studies of other acute stroke models of care Background Following publication of the PRISMA statement , the UK Centre for Review s and Dissemination ( CRD ) at the University of York in Engl and began to develop an international prospect i ve register of systematic review s with health-related outcomes . The objectives were to reduce unplanned duplication of review s and provide transparency in the review process , with the aim of minimizing reporting bias . Methods An international advisory group was formed and a consultation undertaken to establish the key items necessary for inclusion in the register and to gather views on various aspects of functionality . This article describes the development of the register , now called PROSPERO , and the process of registration . Results PROSPERO offers free registration and free public access to a unique prospect i ve register of systematic review s across all areas of health from all around the world . The dedicated web-based interface is electronically search able and available to all prospect i ve registrants . At the moment , inclusion in PROSPERO is restricted to systematic review s of the effects of interventions and strategies to prevent , diagnose , treat , and monitor health conditions , for which there is a health-related outcome .Ideally , registration should take place before the research ers have started formal screening against inclusion criteria but review s are eligible as long as they have not progressed beyond the point of completing data extraction .The required data set captures the key attributes of review design as well as the administrative details necessary for registration .Su bmi tted registration forms are checked against the scope for inclusion in PROSPERO and for clarity of content before being made publicly available on the register , rejected , or returned to the applicant for clarification . The public records include an audit trail of major changes to planned methods , details of when the review has been completed , and links to result ing publications when provided by the authors . Conclusions There has been international support and an enthusiastic response to the principle of prospect i ve registration of protocol s for systematic review s and to the development of PROSPERO .In October 2011 , PROSPERO contained 200 records of systematic review s being undertaken in 26 countries around the world on a diverse range of interventions OBJECTIVES To investigate the effects of intensive acute hospital physiotherapy for patients with isolated hip fractures . DESIGN , SETTING Single-institution , prospect i ve , r and omised trial at a level 1 trauma centre in Melbourne , March 2014 - January 2015 . PARTICIPANTS 92 patients aged 65 years or more with isolated hip fractures . Patients were excluded if the fracture was subtrochanteric or pathological , or if post-operative orders required the patient to be non-weight-bearing on the operated leg . INTERVENTIONS R and omisation to usual care physiotherapy ( daily ; control group ) or intensive physiotherapy ( three times daily ; intervention group ) . MAIN OUTCOME MEASURES Outcomes were assessed at post-operative Day 5 , at discharge , and at 6 months . The primary outcome was the modified Iowa Level of Assistance ( mILOA ) score , with other outcome measures including Timed Up and Go test performance and hospital length of stay ( LOS ) . RESULTS After controlling for sex , anaesthetic type and home setting , the between-group difference in Day 5 mILOA score favoured the intervention group ( mean difference v control group , -2.7 points ; P = 0.04 ) . Hospital LOS was also shorter for the intervention group ( median , 24.4 days v 35.0 days ; P = 0.01 ) . A Cox proportional hazard model that controlled for potential confounders indicated that the probability of discharge was greater for intervention group patients at all time points following surgery ( P < 0.001 ) . Re-admission and complication rates and 6-month outcomes for the two groups were not significantly different . CONCLUSIONS Intensive acute hospital physiotherapy is safe and reduces hospital LOS after an isolated hip fracture . This has the potential to improve bed flow , given the large numbers of inpatient beds occupied by this patient population . TRIAL REGISTRATION Clinical Trials Registry # NCT02088437 Abstract Purpose : To find out how much physical activity in the form of walking can be tolerated by adults admitted for inpatient rehabilitation after hip fracture . Method : Using a phase I dose – response design , in addition to usual scheduled rehabilitation care  participants without cognitive impairment were supervised to walk for a prescribed length of time on 5 consecutive days . Doses started at 3 min and were escalated when three participants successfully completed a dose . Secondary outcomes included physical activity and the Ambulatory Self-Confidence Question naire ( ASCQ ) . Results : The maximum tolerated dose of  walking  for the 13 participants ( 4 men and 9 women ; mean age 81 years , SD 10 ) was 6 min . At 10 min only 1 of 5 participants was able to complete the dose . The main reason for not tolerating the prescribed dose was fatigue . Participants had relatively low levels of daily physical activity ( mean 507 steps/day ) , and lacked confidence in their walking ( ASCQ mean 4.6 ) . Conclusion : Physical activity guidelines for older people are not appropriate for patients in active inpatient rehabilitation recovering from hip fracture where other factors such as fatigue may limit physical activity levels . These results can be taken into account when design ing rehabilitation programmes after hip fracture . Implication s for Rehabilitation Hip fracture is a common and serious fracture with ongoing disability for which people require inpatient rehabilitation to prepare for return to independent living in the community . The maximum tolerated dose of walking of 6 minutes suggests physical activity guidelines for older people are not applicable for those receiving active inpatient rehabilitation after hip fracture . The maximum tolerated dose of walking of 6 minutes during inpatient rehabilitation suggests rehabilitation programmes be structured to allow adequate time for recovery QUESTION Are ambulant patients who are admitted for inpatient rehabilitation for a lower limb orthopaedic condition active enough to meet current physical activity guidelines ? DESIGN Prospect i ve observational study . PARTICIPANTS Adults admitted for inpatient rehabilitation for a lower limb orthopaedic condition who were cognitively alert and able to walk independently or with assistance . OUTCOME MEASURES Participants wore an activity monitor for three full days .  Daily time spent in moderate intensity physical activity  was used to determine whether the levels of physical activity recommended in clinical guidelines were achieved . RESULTS Fifty-four participants with a mean age of 74 years ( SD 11 ) took a median of 398 ( IQR 140 to 993 ) steps per day and spent a median of 8 ( IQR 3 to 16 ) minutes walking per day . No participant completed a 10-minute bout of moderate intensity physical activity during the monitoring period . One participant accumulated 30 minutes of moderate intensity physical activity and nine participants accumulated 15 minutes of moderate intensity physical activity in a day . Physical activity was associated with shorter length of stay ( r=-0.43 ) and higher functional status on discharge ( r=0.39 ) . CONCLUSIONS Adults with lower limb orthopaedic conditions in inpatient rehabilitation are relatively inactive and do not meet current physical activity guidelines for older adults . Results of this study indicate that strategies to increase physical activity are required
target: Conclusion : Based on available evidence , older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery
background: Objective : To synthesize evidence on older adults ’  sedentary behavior and physical activity during rehabilitation and recovery for hip fracture ( 1 ) across the care continuum and ( 2 ) from clinical interventions .