Backward Chaining in der Rehabilitation sturzbedingter Hüftfrakturen

Zusammenfassung

Hintergrund Im Alter gilt die mangelnde Fähigkeit, selbständig vom Boden aufzustehen, als Risikofaktor für zukünftige Stürze und den Schweregrad sturzbedingter Verletzungen. Mit der Backward-Chaining-Methode (BCM) kann diese Fähigkeit verbessert werden.

Ziel In einer Machbarkeitsstudie wurde der Einsatz der BCM bei älteren Patient*innen mit sturzbedingter Hüftfraktur im Rahmen der geriatrischen Rehabilitation untersucht. Der Fokus lag dabei auf der Anwendbarkeit der Methode.

Methode Die Intervention fand im Zeitraum von 2 Wochen 3-mal wöchentlich zusätzlich zum konventionellen Rehabilitationsprogramm erst im physiotherapeutischen Einzel-, später im Gruppensetting statt. Primäre Endpunkte waren Anwendbarkeit und Adhärenz. Sekundäre Endpunkte waren die Auswirkung auf die Sturzangst und die motorischen Fähigkeiten des Sitz-Stand-Transfers, des Gehens und des sicheren Aufstehens vom Boden.

Ergebnisse Mit einer Eignungsrate von 38 und einer Rekrutierungsrate von 82 Prozent der für die Studie geeigneten Proband*innen wurden 14 Patient*innen (mittleres Alter 83 Jahre) einer Rehabilitationseinrichtung in die Studie eingeschlossen. Es gab keine studienbedingten, unerwünschten Ereignisse. Alle Teilnehmenden beendeten die Intervention (100 % Adhärenz). Bezogen auf die Anwendbarkeit ist eine Anpassung der Methode bei Knieschmerzen möglich. Die Medianwerte aller sekundären Endpunkte verbesserten sich im Verlauf der Studie.

Schlussfolgerung Die BCM lässt sich in der geriatrischen Rehabilitation bei Patient*innen mit sturzbedingter Hüftfraktur erfolgreich anwenden. Weitere Studien sollten den Langzeiteffekt der BCM prüfen.

Abstract

Background The inability to get up from the floor independently is considered a significant risk factor for future falls and related to the severity of fall-related injuries. The Backward Chaining Method (BCM) has the potential to influence this ability.

Aim This study examined the feasibility and acceptability of a floor-rise-training using the BCM in a geriatric rehabilitation setting following a fall-related hip fracture.

Method The BCM was offered 3 times per week over a period of 2 weeks as an additional intervention to the standard care rehabilitation program. Participants progressed from individual to group therapy within three weeks. Primary outcome measures included applicability and adherence of the BCM. Secondary outcomes were fear of falling and physical ability of sit-stand transfer, walking and getting up safely from the floor.

Results With an eligibility rate of 38 over 80 percent of eligible patients were recruited resulting in 14 patients (mean age 83 years) from a geriatric rehabilitation hospital. There was no study related adverse events. All participants completed the intervention (100 % adherence). In terms of applicability BCM-adjustments to accommodate lower limb pain is feasible. The median values of all secondary endpoints improved over the course of the study.

Conclusions BCM can be successfully applied in geriatric rehabilitation for patients following fall-related hip fractures, including patient-specific adjustments. Further studies should examine the long-term effect of BCM.

Schlüsselwörter

Backward Chaining - Sturzprävention - Sturzangst - geriatrische Rehabilitation

Keywords

backward chaining - fall prevention - fear of falling - geriatric rehabilitation

Publication History

Received: 12 February 2023

Accepted: 15 July 2024

Article published online:
27 August 2024

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