Impact of psychological resilience on walking capacity in older adults following hip fracture

Abstract

Background: Community-dwelling older adults experiencing hip fracture often fail to achieve adequate walking capacity following surgery and rehabilitation. Effects of psychological factors on post-fracture walking capacity are poorly understood. Accordingly, this paper investigates effects of psychological resilience on observed walking capacity measures in older adults following hip fracture, controlling for important covariates.

Methods: Data were drawn from the Community Ambulation Project, a clinical trial of 210 community-dwelling adults aged ≥60 years who experienced a minimal trauma hip fracture and were randomized to one of two 16-week home-based physical therapist-guided interventions. Psychological resilience was measured at study baseline using the 6-item Brief Resilience Scale (BRS); scores were classified into groups in order to distinguish levels of self-reported resilience. Walking capacity was assessed at study baseline and 16 weeks later using 4-Meter Gait Speed (4MGS), 50-Foot Walk Test (50FWT), and 6-Minute Walk Distance (SMWD). In multivariate analyses of covariance in which 16-week follow-up values of each walking measure were outcomes, covariates included clinical trial arm, gender, age, and baseline values of: walking measure corresponding to the outcome; body mass index; depressive symptom severity; degree of psychological optimism; cognitive status; informal caregiver need; and days from hospital admission to randomization.

Results: Increases between baseline and 16 weeks later in mean gait speed in meters/sec (m/s) and walking distance in meters (m) in 4MGS, 50FWT and SMWD were 0.06 m/s (p = 0.061), 0.11 m/s (p < 0.01), and 25.5 m (p = 0.056) greater, respectively, in the most resilient BRS group compared to the least resilient BRS group.

Conclusion: Higher levels of psychological resilience were associated with greater walking speed and distance. Psychological resilience represents a potentially clinically important pathway and intervention target, toward the goal of improving walking capacity among older adults known to have substantial residual disability following hip fracture.

Keywords: hip fracture; older adults; psychological resilience; walking capacity.

Figure 1.. Study Participant Flow Diagram.

^aReasons for missing data in parent study: 11 voluntarily withdrew; 3 physical limitation; 3 refused; 2 died; 1 cognitive impairment; 1 technical difficulty; 1 withdrawn by clinical site; 1 lost to follow-up SMWD = Six-Minute Walk Distance (primary parent study outcome); 50FWT = 50-Foot Walk Test; 4MGS = 4-Minute Gait Speed

Figure 2.. Average Increase from Baseline to 16-week follow-up in Gait Speed for the 4-Meter Gait Speed and 50-Foot Walk Test, and in Distance Walked for the Six-Minute Walk Distance, in Higher Resilience Groups Compared to Lowest Resilience (Brief Resilience Scale [BRS] < 3.0) Group^┼.

^┼Average increase in gait speed and distance walked values shown are at 16-week follow-up, adjusting for baseline speed/distance and other covariates (see text). BRS < 3.0: 4-Meter Gait Speed (n = 51), 50-Foot Walk Test (n = 49), Six-Minute Walk Distance (n = 52).