The effect of motivational interviewing on physical activity after hip fracture: a multisite, open-label, randomised controlled trial in Australia

Abstract

Background: Hip fracture has profound psychosocial effects but there is little guidance about how to incorporate management of psychosocial factors into rehabilitation. We aimed to assess the effect of telephone-based motivational interviewing on physical activity in community-dwelling older adults after hip fracture.

Methods: We conducted a 12-month, assessor-masked, open-label, multisite, randomised controlled trial in three health networks (Eastern Health, Peninsula Health, and Alfred Health) in Melbourne, VIC, Australia. Each health network included acute hospitals, sub-acute (rehabilitation) hospitals, and community rehabilitation programmes from which eligible participants were recruited. Community-dwelling adults with hip fracture, aged 65 years and older, were randomly assigned (1:1) by an external provider with a random number generator to an experimental group receiving ten 30-min sessions of motivational interviewing over 16 weeks from one of 13 trained health professionals or to an attention-control group receiving an equivalent dosage of dietary advice from one of nine accredited dietitians. Assessors were masked to group allocation. The primary outcome, assessed in the intention-to-treat population, was physical activity expressed as accelerometer-measured daily walking time at week 52. All available data were used in the linear mixed effects models. To account for missing data, multiple imputation was completed as a sensitivity analysis. The study was registered prospectively (ACTRN12619000936123).

Findings: From Sept 29, 2019, to June 27, 2022, 1246 potentially eligible patients were screened, 1046 were excluded (611 were deemed ineligible, 359 declined to participate, and 76 were unable to be contacted) and the resulting 200 were randomly assigned to an intervention (98 assigned to the motivational interviewing group and 102 assigned to the nutritional education control group). 146 (73%) participants were female, 54 (27%) were male, the average age of participants was 79 years (SD 7), and participants were a mean of 89 days (SD 40) days post-surgery at baseline. Daily walking time at week 52 was a median of 53·1 min (IQR 28·8 to 73·8) in the motivational interviewing group and 63·7 min (42·6 to 89·2) in the control group, with no significant between-group differences (mean difference 4·1% [95% CI -16·6 to 21·1). There were no serious harms related to the intervention. There were seven deaths during the period from baseline to week 52, three in the motivational interviewing group and four in the control group. There were a small number of non-serious adverse events related to the intervention with a total of seven (1%) short-term skin reactions out of 668 assessments in response to the activity monitor being held in place on the thigh with dressing.

Interpretation: Motivational interviewing was no more effective than dietary advice in increasing physical activity in the form of daily walking for community-dwelling older adults after hip fracture. The most effective way of addressing psychosocial challenges during hip fracture rehabilitation remains uncertain.

Funding: National Health and Medical Research Council, Australia.