Dokument: Auswirkungen rehabilitativer Interventionen zur Reduktion der Sturzangst und zur Erhöhung der sturzbezogenen Selbstwirksamkeit bei älteren Menschen mit Hüftfrakturen: eine systematische Übersichtsarbeit
| Titel: | Auswirkungen rehabilitativer Interventionen zur Reduktion der Sturzangst und zur Erhöhung der sturzbezogenen Selbstwirksamkeit bei älteren Menschen mit Hüftfrakturen: eine systematische Übersichtsarbeit | |||||||
| Weiterer Titel: | Effects of rehabilitative interventions to reduce fear of falling and increase falls efficacy in older people with hip fracture: a systematic review | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=68831 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20250310-150236-5 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Federwisch, Christian Markus [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Möhler, Ralph [Gutachter] Prof. Dr. phil. Sascha Köpke [Gutachter] | |||||||
| Stichwörter: | Systematische Übersichtsarbeit, Rehabilitative Interventionen, Hüftfraktur, Sturzangst, Sturzbezogene Selbstwirksamkeit, systematic review, rehabilitative interventions, hip fracture, fear of falling, falls efficacy | |||||||
| Dokumententyp (erweitert): | Dissertation | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Zusammenfassung
Hintergrund: Hüftfrakturen stellen ein großes gesundheitliches Problem für ältere Menschen dar. Die funktionelle Rehabilitation dieser PatientInnen ist von großer Bedeutung, aber auch die psychischen Folgen von Hüftfrakturen, wie Sturzangst, rücken zunehmend in den Vordergrund. Studien zeigen eine hohe Prävalenz von Sturzangst bei älteren Menschen mit Hüftfrakturen. Diese wird unter anderem mit selbst auferlegten Einschränkungen der Betroffenen bei körperlichen und sozialen Aktivitäten in Verbindung gebracht. Daher ist es wichtig für dieses Patientenkollektiv Interventionen zu entwickeln, welche die Sturzangst der PatientInnen verbessern, um eine optimale Rehabilitation zu gewährleisten. Ziele der Arbeit: Erstes Ziel war es Sturzangst anhand des aktuellen Forschungsstands zu definieren und die Möglichkeiten der Operationalisierung und Quantifizierung aufzuführen. Das Hauptziel war es den Effekt von Interventionen zur Reduktion von Sturzangst bei älteren Menschen nach Hüftfraktur zu untersuchen und im Rahmen dessen eine Interventionsanalyse durchzuführen. Methoden: Dieses Review wurde nach den Methoden von Cochrane erstellt. Das Protokoll wurde bei PROSPERO registriert (CRD42023393105). Die systematische Literaturrecherche erfolgte in MEDLINE via PubMed, CENTRAL und CINAHL. Eingeschlossen wurden alle randomisierten kontrollierten Studien zu Interventionen, die explizit Sturzangst bei älteren Menschen nach einer Hüftfraktur adressierten und Sturzangst als Outcome untersuchten. Als sekundärer Endpunkt wurden unerwünschte Ereignisse untersucht. Die Datenextraktion, die Interventionsanalyse, das Risk of Bias-Assessment und die Bewertung der Evidenz erfolgten systematisch. Die Studienauswahl, die Datenextraktion und die Bewertung des Bias-Risikos wurde unabhängig von zwei ReviewerInnen durchgeführt. Ergebnisse: Die Literaturrecherche wurde im März 2023 durchgeführt und ergab 5877 Treffer, von denen 31 im Volltext gesichtet wurden. Es wurden vier Studien eingeschlossen, welche aus Hongkong, Deutschland, Schweden und den Niederlanden stammten. Die Gesamtzahl der StudienteilnehmerInnen betrug n = 429 und das Durchschnittsalter betrug 81 Jahren. 77% der ProbandInnen waren weiblich. Zwei Interventionen beinhalteten kognitiv behaviorale bzw. verhaltenstherapeutische Elemente. Eine Studie untersuchte ein Empowerment-Programm für PatientInnen und deren pflegende Angehörige. Die letzte Studie evaluierte ein multiprofessionelles Entlassmanagement mit anschließender häuslicher Rehabilitation zur Reduktion der Sturzangst. Die Kontrollgruppen erhielten die Standardversorgung für PatientInnen mit Hüftfrakturen. Die Studien zeichneten sich im Hinblick auf die implementierten Interventionen und die Therapiedauer, sowie bezüglich der Endpunktmessungen durch eine hohe Heterogenität aus. Zudem wiesen alle Studien verschiedene methodische Limitierungen auf, z. B. bei der Randomisierung der StudienteilnehmerInnen oder der Vollständigkeit der Ergebnisdaten. In der Folge konnte für den primären Endpunkt Sturzangst ausschließlich Evidenz von „sehr geringer Vertrauenswürdigkeit “ gefunden werden und somit keine Aussage über den Nutzen dieser Interventionen zur Reduktion von Sturzangst bei älteren Menschen nach Hüftfraktur getroffen werden. Für den sekundären Endpunkt lag Evidenz von „geringer Vertrauenswürdigkeit“ dafür vor, dass kognitiv-behaviorale Interventionen vermutlich einen kleinen oder keinen Unterschied für das Auftreten unerwünschter Ereignisse bedingen. Für die übrigen Interventionen lag Evidenz von „sehr geringer Vertrauenswürdigkeit“ vor und es konnte somit keine Aussage über die Sicherheit dieser Interventionen getroffen werden. Diskussion: Obwohl eine erhöhte Sturzangst als ein wichtiger Risikofaktor für ein erhöhtes Sturzrisiko gilt, liegen nur wenige Studien vor, die spezifische Interventionen zur Verringerung einer Sturzangst bei Personen mit einer Hüftfraktur evaluiert haben. Basierend auf diesem systematischen Review sind wir unsicher über den Nutzen rehabilitativer Interventionen zur Reduktion von Sturzangst bei älteren Menschen nach Hüftfrakturen. Bei der Konzeption zukünftiger Interventionsstudien mit dem Fokus Sturzangst sollte auf die Auswahl geeigneter Instrumente zur Erhebung sensibilisiert werden.Abstract Background: Hip fractures are a major health problem for older people. The functional rehabilitation of these patients is of great importance, but the psychological consequences of hip fractures, such as fear of falling, are also increasingly coming to the fore. Studies show a high prevalence of fear of falling in older people with hip fractures. This is associated with self-imposed limitations in physical and social activities, among other things. It is therefore important to develop interventions for this patient group that improve patients' fear of falling to ensure optimal rehabilitation. Objectives: The first aim was to define fear of falling based on the current state of research and to list the possibilities of operationalization and quantification. The main aim was to investigate the effect of interventions to reduce fear of falling in older people after hip fracture as well as to carry out an intervention analysis. Methods: This review was conducted according to the methods published by Cochrane. The protocol was registered with PROSPERO (CRD42023393105). A systematic literature search was conducted in MEDLINE via PubMed, CENTRAL and CINAHL. All randomized controlled trials of interventions that explicitly addressed fear of falling in older people after hip fracture and investigated fear of falling as an outcome were included. Adverse events were examined as a secondary endpoint. Data extraction, intervention analysis, risk of bias assessment and evidence appraisal were done systematically. Study selection, data extraction and risk of bias assessment were performed independently by two reviewers. Results: A literature search was conducted in March 2023 and resulted in 5877 hits, of which 31 were screened in full text. Four studies from Hong Kong, Germany, Sweden and the Netherlands were included. The total number of study participants was n = 429 and the average age was 81 years. 77% of the participants were female. Two interventions included cognitive behavioral and behavioral therapy elements. One study investigated an empowerment program for patients and their family caregivers, and the last study evaluated a multiprofessional discharge management with subsequent home rehabilitation to reduce fear of falling. The control groups received usual care for patients with hip fractures. The studies were characterized by pronounced heterogeneity regarding the intervention implemented and the duration of therapy, as well as regarding the outcome measurement. In addition, all studies had various methodological limitations, e.g. in the randomization of study participants or the completeness of the outcome data. As a result, only very low-certainty evidence was found for the primary outcome “fear of falling” and we are uncertain about the effects of these interventions in reducing fear of falling in older people after hip fracture. For the secondary outcome, there was low-certainty evidence that cognitive-behavioral interventions result in little or no difference in the frequency of adverse events. For the other interventions, very low certainty evidence was found and as a result we are uncertain about the safety of these interventions. Discussion: Although increased fear of falling is considered an important risk factor of increased risk of falling, there are few studies that have evaluated specific interventions to reduce fear of falling in people with a hip fracture. Based on this systematic review, we are uncertain about the benefits of rehabilitative interventions to reduce fear of falling in older people after hip fracture. The design of future intervention studies focusing on fear of falling should be sensitized to the selection of appropriate instruments for outcome assessment. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät » Institute » Institut für Versorgungsforschung und Gesundheitsökonomie | |||||||
| Dokument erstellt am: | 10.03.2025 | |||||||
| Dateien geändert am: | 10.03.2025 | |||||||
| Promotionsantrag am: | 05.09.2024 | |||||||
| Datum der Promotion: | 25.02.2025 |
