We aimed to determine if motivational interviewing could increase walking in community-dwelling older adults after hip fracture compared with an attention-matched control group receiving dietary advice.
This study was a 12 month, single-blind, multi-site randomised controlled trial with embedded economic evaluation completed at three publicly funded health networks in Melbourne, Australia. Participants were community-dwelling adults with hip fracture aged ≥65 years who had been discharged from hospital and were able to participate in telephone conversations. A key exclusion criterion was reduced cognitive capacity. Participants were randomised to an experimental group receiving 10 x 30-minute sessions of motivational interviewing over 16 weeks from a trained health professional (7 of12 were physiotherapists), or to an attention-control group receiving an equivalent dosage of dietary advice from a dietitian. The primary outcome was accelerometer-measured daily walking time at week 52. Secondary outcomes included physical activity, mobility, psychological function, health-related quality of life, cost, falls and weight. Primary analyses evaluated between-group differences with linear mixed effects. The economic evaluation was a cost effectiveness analysis from the perspective of the health care system.
Of 200 randomised participants (mean age 79 [SD 7] years; 73% women) who completed baseline testing at a mean of 87 (SD 46) days after fracture, the primary outcome was obtained from 169 (85%) at week 9 and 147 (74%) at week 52. There were no significant between-group differences in any primary or secondary outcomes at week 52, apart from weight gain in men in the dietary advice group (MD 3.66 kg, 95%CI 0.29, 7.03, P=.034). Daily walking time (minutes) increased from 45.9 (IQR 29.0, 62.0) at week 0 to 53.1 (IQR 28.6, 74.5) at week 52 in the experimental group, and from 50.3 (IQR 29.5, 62.5) to 63.7 (IQR 42.4, 91.5) in the control group without between-group difference (MD -1.8 min, 95%CI, -15.1, 10.0). Within-group, daily walking time at moderate intensity increased by 45% (95%CI 22, 72) in the experimental group and by 52% (95%CI 28, 79) in the control group at week 52. Including the cost of training motivational interviewers, experimental group costs were higher (MD AUD$1,109, 95%CI -$8, $2,225).
Motivational interviewing was no more effective than dietary advice and not cost effective in increasing daily walking time for community-dwelling older adults after hip fracture. While both interventions may have been similarly ineffective, consistent, small to moderate positive changes in both groups suggest the common features of support, connection and setting expectations provided to all participants may have positively impacted outcomes.
These findings do not support the specific use of motivational interviewing by physiotherapists during rehabilitation after hip fracture but suggest continuing therapeutic support and connection beyond usual care rehabilitation may improve outcomes.
physical activity
rehabilitation
