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" משתנים פסיכולוגיים חיוביים, יכולת תפקודית, השתתפות ותפיסת איכות חיים בקרב קשישים לאחר שבר בצוואר הירך "
Segev-Jacubovski, Orit
Maeir, Adina
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Latin Dissertation
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English
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| Record Number
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1059110
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TL58227
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| Main Entry
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Segev-Jacubovski, Orit
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| Title & Author
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משתנים פסיכולוגיים חיוביים, יכולת תפקודית, השתתפות ותפיסת איכות חיים בקרב קשישים לאחר שבר בצוואר הירך\ Segev-Jacubovski, OritMaeir, Adina
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| College
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The Hebrew University of Jerusalem (Israel)
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| Date
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2019
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| Degree
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Ph.D.
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2019
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| Note
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115 p.
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| Abstract
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Background and objectives of the study. Hip fractures are prevalent among older adults and recognized to be a major public health problem in many Western nations. Hip fractures, particularly in elderly, result in loss of independence in ambulation, limits in activities of daily living (ADL) and instrumental ADL (IADL), and restrictions in participation in daily life situations even one year following the fracture. Additionally, hip fracture results in decreases in health-related quality of life (HRQoL). The deterioration of physical and mental HRQoL in this population has been observed even 2-years after the hip fracture. Thus, numerous studies have documented psychological and physical barriers to successful rehabilitation outcomes. In contrast, only few studies have examined the relationship between positive psychological factors, which can facilitate rehabilitation at short-term or long-term rehabilitation outcomes among older adults after hip fracture. In recent years, there has been an advance in investigating the role of positive psychological factors such as positive affect, optimism and hope in the field of medicine and rehabilitation. Positive psychological factors have been related to better outcomes among older adults with various health conditions. However, the existing literature about the correlation of positive psychological factors with rehabilitation outcomes, such as functional ability or participation, among hip fracture in older adults is limited. Moreover, the results of existing studies are inconsistent, and the methodology is varied. More generally, the existing literature about restriction in participation at long-term among older adults after hip fracture is limited, and only few studies have examined the correlations between HRQoL and comprehensive rehabilitation outcomes: ADL, IADL and participation in this population. This information can assist therapists in identifying psychological strengths that could help individuals who are coping with long-term reduced function, participation and HRQoL due to physical disability. In addition, understanding the relationships between HRQoL, function and participation can support pathways for promoting these aspects during the rehabilitation process. Therefore, the goals of this research project were to: 1) to examine the recovery trajectory of ADL/IADL functioning and participation among older adults with hip fracture 6-months after discharge from rehabilitation, and to compare their pre-fracture and post-rehabilitation functional status and participation levels. 2) to examine the role of positive psychological factors in the rehabilitation process of older adults with hip fracture; both during the acute-rehabilitation phase and 6-months after discharge from rehabilitation. 3) to examine which positive psychological and physical factors would explain functional ability and participation, as measured at the same time. 4) to examine the correlations between HRQoL, ADL/IADL functioning and participation 6-months after discharge from rehabilitation. 5) to determine which variables relating to function and participation contribute to the prediction of HRQoL. Method. Both retrospective and prospective cohort design were used in this study. Participants. In the acute-rehabilitation phase, seventy-one participants who sustained a hip fracture due to a fall were recruited from a university-affiliated major inpatient post-acute geriatric rehabilitation center, admitting older patients from nearby hospitals. The mean age of the sample was 75.58 (SD = 6.09), and fifty-two of the participants were female (73.2%). All the participants received physical and occupational therapy during the acute phase of rehabilitation. Fifty-five participants were included in the follow-up phase, 6-months post rehabilitation, with mean age of 80.82 (SD = 5.69), and thirtynine of the participants were female (70.9%). Instruments. Positive psychological factors were examined by self-report questionnaires, the Positive Affect questionnaire, Life Orientation Test (LOT) and Adult Hope Scale (AHS). Additionally, hand grip strength and pain were used as estimates of general physical condition. Rehabilitation outcomes were the Functional Independence Measure Motor Scale (mFIM), Lawton Instrumental Activities of Daily Living Scale (IADL), the Activity Card Sort (ACS) measuring participation and the Short-Form Health Status Survey (SF-12). Procedure. Positive psychological factors and physical factors were administered in acute-rehabilitation phase and 6-months after rehabilitation. The outcome measures, mFIM, ACS, IADL were administered pre-fracture and at follow-up. Additionally, mFIM was administered in admission and discharge from ward. The SF-12 was administered only at follow-up. Results. Pre-fracture levels of function and participation were not attained at follow-up. Positive psychological factors and functional outcome in acute-rehabilitation. Significant correlations were found between the mFIM, positive affect and hand grip strength. Hierarchal regression analysis for predicting mFIM at discharge revealed a significant effect of age, FIM at admission, and hand grip strength. Positive psychological factors and functional outcome at follow-up. Functional ability was significantly correlated with positive affect, optimism, the hope-pathways component and hand grip strength. Participation was significantly correlated with optimism, the hope-agency and the hope-pathways components. According to a stepwise linear regression, optimism and hand grip strength significantly explained the mFIM. In addition, the hope total score significantly explained the ACS. HRQoL, functional ability and participation at follow-up. Significant correlations were found between HRQoL, functional abilities and participation. ADL functioning and mobility predicted Physical SF-12, whereas social-cultural activity predicted Mental SF-12. Conclusion. The current findings showed that significant loss of functioning and participation was found, persisting 6-months after rehabilitation that impede their HRQoL. Additionally, participation in ADL, mobility and social-cultural activities contribute towards the prediction of HRQoL among this population. These findings are compatible with the positions of the American Occupational Therapy Association (AOTA, 2014) as well as the WHO (ICF, 2001) that emphasize the importance of participation and occupation for promoting health and quality of life. Regarding positive psychological factors, the current findings provide evidence that optimism and hope play a role in functional ability and participation in older adults with hip fracture, 6-month post rehabilitation. However, at acute-rehabilitation only positive affect was associated with functional ability. From a clinical perspective, comprehensive rehabilitation evaluation should pay attention to positive psychological factors that may enhance the rehabilitation outcomes of older adults with hip fracture. In addition, long-term rehabilitation intervention should aim at bolstering optimism and hope as a potential powerful method of channeling patients' psychological resources to influence their physical recovery.
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| Descriptor
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Activities of daily living
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Age
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Arthritis
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Blood pressure
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Bone surgery
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Disability
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Fractures
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Geriatrics
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Gerontology
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Heart attacks
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Injuries
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Mental depression
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Mental health
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Nursing homes
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Older people
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Osteoporosis
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Pain
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Physical therapy
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Public health
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Stroke
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Maeir, Adina
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The Hebrew University of Jerusalem (Israel)
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