Construction of intervention program for postoperative fear of falling in elderly patients with hip fracture based on cognitive behavioral theory_West China Medical Journal

Authors：

DONG Fanghui ^1,2 ,  HU Sanlian ² , ZHANG Yajuan ³ , WEI Xiaomei ²

1. Shanghai Jiao Tong University School of Nursing, Shanghai 200025, P. R. China;
2. Department of Orthopaedic, Sixth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, P. R. China;
3. Intensive Care Unit, Sixth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, P. R. China;

Corresponding author：

HU Sanlian, Email: liuliu9027@163.com

Keywords：

Cognitive behavioral theory; elderly; hip fracture; fear of falling; intervention; program

DOI：

10.7507/1002-0179.202508064

Video：

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Objective To construct an intervention program for postoperative fear of falling in elderly patients with hip fracture based on cognitive behavioral theory. Methods Based on cognitive-behavioral theory and literature review, an initial draft of an intervention plan for postoperative fear of falling in elderly patients with hip fracture was constructed. From January to March 2025, after two rounds of expert consultations and revisions, the final plan was formed. Results A total of 16 experts across the country were invited to participate in two rounds of Delphi expert consultations, covering areas such as orthopedic clinical nursing, orthopedic clinical medicine, nursing education, nursing management, rehabilitation therapy, and psychological therapy. The active participation rates for the two rounds of consultations were 94.12% and 100%, respectively. The expert authority coefficients were 0.860 and 0.907, and the Kendall harmony coefficients were 0.369 and 0.524. Ultimately, 5 primary indicators (fall fear management team, fall fear management goals, fall fear assessment, fall fear intervention measures, and post-intervention effect evaluation), 17 secondary indicators, and 31 tertiary indicators were constructed. Conclusion The intervention program for postoperative fear of falling in elderly patients with hip fracture based on cognitive behavior theory constructed in this study is scientific and operable, which can provide reference and guidance for clinical nursing staff.

1.	Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr, 2023, 23(1): 385.
2.	闵春燕, 段菲, 王淑勉, 等. 全髋关节置换患者术后跌倒恐惧现况及其对髋关节功能恢复的影响分析. 中华现代护理杂志, 2023, 29(3): 324-329.
3.	查玉梅, 单雪, 李慢慢, 等. 老年股骨转子间骨折术后患者跌倒恐惧风险预测模型的构建与验证. 中国实用护理杂志, 2024, 40(14): 1097-1104.
4.	Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, et al. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr, 2021, 21(1): 224.
5.	Scheffers-Barnhoorn MN, van Haastregt JC, Schols JM, et al. A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial. BMC Geriatr, 2017, 17(1): 71.
6.	Jefferis BJ, Iliffe S, Kendrick D, et al. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?. BMC Geriatr, 2014, 14: 114.
7.	赵巧玉, 纪代红, 张岩. 奥塔戈运动项目对老年股骨颈骨折患者害怕跌倒心理的影响. 长春中医药大学学报, 2019, 35(2): 349-352.
8.	侯晨霞, 陈彦玲, 刘瑞, 等. 基于信息-动机-行为技巧模型的早期康复管理在老年髋部骨折患者跌倒恐惧中的应用研究. 中国康复医学杂志, 2022, 37(12): 1685-1689.
9.	Lenouvel E, Ullrich P, Siemens W, et al. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev, 2023, 11(11): CD014666.
10.	朱俊美, 周娟. 认知行为团体心理护理干预对膝关节置换术患者术后恐动症及心理状况的影响. 护理实践与研究, 2021, 18(23): 3563-3567.
11.	杨恬甜, 李玉伟, 王群涛, 等. 认知行为干预联合康复锻炼对腰椎间盘突出症术后腰椎功能康复和恐动程度的影响. 中国疗养医学, 2022, 31(10): 1079-1083.
12.	龚珏如, 黄庆玲, 邓平, 等. 基于认知行为疗法的自我睡眠管理改善慢性失眠的临床初探. 中风与神经疾病杂志, 2024, 41(3): 215-218, 289.
13.	Kumar A, Delbaere K, Zijlstra GA, et al. Exercise for reducing fear of falling in older people living in the community: cochrane systematic review and meta-analysis. Age Ageing, 2016, 45(3): 345-352.
14.	李硕, 金晓燕, 高凤莉. 基于结构-过程-结果模型日间化疗护理敏感质量指标体系的构建. 华西医学, 2025, 40(2): 261-268.
15.	车志刚, 李芸芸, 戴狄莎, 等. 基于认知行为理论的健康指导对高血压性心脏病患者的干预效果分析. 长春中医药大学学报, 2021, 37(2): 410-412.
16.	李峥. 认知行为干预对口腔肿瘤病人疾病恐惧和睡眠质量的影响. 护理研究, 2021, 35(3): 534-537.
17.	程岚, 吴奕帆, 王汇, 等. 基于认知行为理论构建肺癌病人戒烟管理方案. 护理研究, 2023, 37(17): 3099-3105.
18.	李健芝, 胡丽, 李忠玉, 等. 护理学混合式教学质量多主体评价指标体系的构建研究. 中华护理教育, 2025, 22(2): 177-184.
19.	崔金燕, 吴丽娟, 孟佶茹, 等. 认知行为干预在老年髋部骨折病人跌倒恐惧中的应用效果. 骨科, 2021, 12(2): 165-169.
20.	杨晓梅, 马彩莉, 苏靖, 等. 基于互联网的 OEP 锻炼对害怕跌倒老年人心理及活动能力的影响. 临床护理杂志, 2022, 21(4): 53-55.
21.	王彭, 王丽梅, 李桂萍, 等. 多学科团队协作干预模式对老年住院患者术后早期跌倒恐惧的影响. 中华现代护理杂志, 2023, 29(7): 935-939.
22.	周巧, 颜笛玉. 奥塔戈运动锻炼项目对跌倒恐惧老年患者的应用效果. 中国临床护理, 2021, 13(1): 30-31,35.
23.	顾颖, 沈莹, 余小萍, 等. 奥塔戈运动在害怕跌倒老年人中的应用效果. 护理研究, 2020, 34(7): 1253-1256.
24.	Pfeiffer K, Kampe K, Klenk J, et al. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age Ageing, 2020, 49(5): 771-778.
25.	Genç FZ, Bilgili N. The effect of Otago exercises on fear of falling, balance, empowerment and functional mobility in the older people: randomized controlled trial. Int J Nurs Pract, 2023, 29(6): e13194.
26.	Scheffers-Barnhoorn MN, van Eijk M, van Haastregt JCM, et al. Effects of the FIT-HIP intervention for fear of falling after hip fracture: a cluster-randomized controlled trial in geriatric rehabilitation. J Am Med Dir Assoc, 2019, 20(7): 857-865. e2.
27.	Huang TT, Yang LH, Liu CY. Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial. J Adv Nurs, 2011, 67(5): 961-971.
28.	Crandall M, Duncan T, Mallat A, et al. Prevention of fall-related injuries in the elderly: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, 2016, 81(1): 196-206.
29.	Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing, 2022, 51(9): afac205.
30.	中华护理学会骨科护理专业委员会, 陈亚萍, 佟冰渡, 等. 老年髋部骨折综合管理与二次骨折预防的专家共识. 中华创伤骨科杂志, 2020, 22(6): 461-469.
31.	皮红英, 高远, 候惠如, 等. 老年人跌倒风险综合管理专家共识. 中华保健医学杂志, 2022, 24(6): 439-441.
32.	中国老年保健医学研究会老龄健康服务与标准化分会, 《中国老年保健医学》杂志编辑委员会. 中国老年人跌倒风险评估专家共识(草案). 中国老年保健医学, 2019, 17(4): 47-48,50.
33.	薛亚萍, 丁亚萍, 余洁, 等. 认知行为干预对老年人害怕跌倒和平衡能力影响的 Meta 分析. 护理研究, 2021, 35(10): 1720-1725.
34.	Bower ES, Wetherell JL, Petkus AJ, et al. Fear of falling after hip fracture: prevalence, course, and relationship with one-year functional recovery. Am J Geriatr Psychiatry, 2016, 24(12): 1228-1236.
35.	Bower ES, Wetherell JL, Petkus AJ, et al. Neuroticism predicts fear of falling after hip fracture. Int J Geriatr Psychiatry, 2020, 35(5): 498-506.
36.	徐雅琴, 谢彩霞. 髋部骨折病人跌倒恐惧的研究进展. 护理研究, 2022, 36(21): 3856-3859.
37.	尹航. 老年髋部骨折患者肌肉衰减症、营养状况与跌倒风险的相关性研究. 吉林延吉: 延边大学, 2020.
38.	孙敬博, 于潇, 张新玉, 等. 决策辅助对全髋关节置换术患者功能锻炼依从性的效果观察. 护理实践与研究, 2025, 22(4): 620-626.

1. Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr, 2023, 23(1): 385.
2. 闵春燕, 段菲, 王淑勉, 等. 全髋关节置换患者术后跌倒恐惧现况及其对髋关节功能恢复的影响分析. 中华现代护理杂志, 2023, 29(3): 324-329.
3. 查玉梅, 单雪, 李慢慢, 等. 老年股骨转子间骨折术后患者跌倒恐惧风险预测模型的构建与验证. 中国实用护理杂志, 2024, 40(14): 1097-1104.
4. Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, et al. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr, 2021, 21(1): 224.
5. Scheffers-Barnhoorn MN, van Haastregt JC, Schols JM, et al. A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial. BMC Geriatr, 2017, 17(1): 71.
6. Jefferis BJ, Iliffe S, Kendrick D, et al. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?. BMC Geriatr, 2014, 14: 114.
7. 赵巧玉, 纪代红, 张岩. 奥塔戈运动项目对老年股骨颈骨折患者害怕跌倒心理的影响. 长春中医药大学学报, 2019, 35(2): 349-352.
8. 侯晨霞, 陈彦玲, 刘瑞, 等. 基于信息-动机-行为技巧模型的早期康复管理在老年髋部骨折患者跌倒恐惧中的应用研究. 中国康复医学杂志, 2022, 37(12): 1685-1689.
9. Lenouvel E, Ullrich P, Siemens W, et al. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev, 2023, 11(11): CD014666.
10. 朱俊美, 周娟. 认知行为团体心理护理干预对膝关节置换术患者术后恐动症及心理状况的影响. 护理实践与研究, 2021, 18(23): 3563-3567.
11. 杨恬甜, 李玉伟, 王群涛, 等. 认知行为干预联合康复锻炼对腰椎间盘突出症术后腰椎功能康复和恐动程度的影响. 中国疗养医学, 2022, 31(10): 1079-1083.
12. 龚珏如, 黄庆玲, 邓平, 等. 基于认知行为疗法的自我睡眠管理改善慢性失眠的临床初探. 中风与神经疾病杂志, 2024, 41(3): 215-218, 289.
13. Kumar A, Delbaere K, Zijlstra GA, et al. Exercise for reducing fear of falling in older people living in the community: cochrane systematic review and meta-analysis. Age Ageing, 2016, 45(3): 345-352.
14. 李硕, 金晓燕, 高凤莉. 基于结构-过程-结果模型日间化疗护理敏感质量指标体系的构建. 华西医学, 2025, 40(2): 261-268.
15. 车志刚, 李芸芸, 戴狄莎, 等. 基于认知行为理论的健康指导对高血压性心脏病患者的干预效果分析. 长春中医药大学学报, 2021, 37(2): 410-412.
16. 李峥. 认知行为干预对口腔肿瘤病人疾病恐惧和睡眠质量的影响. 护理研究, 2021, 35(3): 534-537.
17. 程岚, 吴奕帆, 王汇, 等. 基于认知行为理论构建肺癌病人戒烟管理方案. 护理研究, 2023, 37(17): 3099-3105.
18. 李健芝, 胡丽, 李忠玉, 等. 护理学混合式教学质量多主体评价指标体系的构建研究. 中华护理教育, 2025, 22(2): 177-184.
19. 崔金燕, 吴丽娟, 孟佶茹, 等. 认知行为干预在老年髋部骨折病人跌倒恐惧中的应用效果. 骨科, 2021, 12(2): 165-169.
20. 杨晓梅, 马彩莉, 苏靖, 等. 基于互联网的 OEP 锻炼对害怕跌倒老年人心理及活动能力的影响. 临床护理杂志, 2022, 21(4): 53-55.
21. 王彭, 王丽梅, 李桂萍, 等. 多学科团队协作干预模式对老年住院患者术后早期跌倒恐惧的影响. 中华现代护理杂志, 2023, 29(7): 935-939.
22. 周巧, 颜笛玉. 奥塔戈运动锻炼项目对跌倒恐惧老年患者的应用效果. 中国临床护理, 2021, 13(1): 30-31,35.
23. 顾颖, 沈莹, 余小萍, 等. 奥塔戈运动在害怕跌倒老年人中的应用效果. 护理研究, 2020, 34(7): 1253-1256.
24. Pfeiffer K, Kampe K, Klenk J, et al. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age Ageing, 2020, 49(5): 771-778.
25. Genç FZ, Bilgili N. The effect of Otago exercises on fear of falling, balance, empowerment and functional mobility in the older people: randomized controlled trial. Int J Nurs Pract, 2023, 29(6): e13194.
26. Scheffers-Barnhoorn MN, van Eijk M, van Haastregt JCM, et al. Effects of the FIT-HIP intervention for fear of falling after hip fracture: a cluster-randomized controlled trial in geriatric rehabilitation. J Am Med Dir Assoc, 2019, 20(7): 857-865. e2.
27. Huang TT, Yang LH, Liu CY. Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial. J Adv Nurs, 2011, 67(5): 961-971.
28. Crandall M, Duncan T, Mallat A, et al. Prevention of fall-related injuries in the elderly: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, 2016, 81(1): 196-206.
29. Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing, 2022, 51(9): afac205.
30. 中华护理学会骨科护理专业委员会, 陈亚萍, 佟冰渡, 等. 老年髋部骨折综合管理与二次骨折预防的专家共识. 中华创伤骨科杂志, 2020, 22(6): 461-469.
31. 皮红英, 高远, 候惠如, 等. 老年人跌倒风险综合管理专家共识. 中华保健医学杂志, 2022, 24(6): 439-441.
32. 中国老年保健医学研究会老龄健康服务与标准化分会, 《中国老年保健医学》杂志编辑委员会. 中国老年人跌倒风险评估专家共识(草案). 中国老年保健医学, 2019, 17(4): 47-48,50.
33. 薛亚萍, 丁亚萍, 余洁, 等. 认知行为干预对老年人害怕跌倒和平衡能力影响的 Meta 分析. 护理研究, 2021, 35(10): 1720-1725.
34. Bower ES, Wetherell JL, Petkus AJ, et al. Fear of falling after hip fracture: prevalence, course, and relationship with one-year functional recovery. Am J Geriatr Psychiatry, 2016, 24(12): 1228-1236.
35. Bower ES, Wetherell JL, Petkus AJ, et al. Neuroticism predicts fear of falling after hip fracture. Int J Geriatr Psychiatry, 2020, 35(5): 498-506.
36. 徐雅琴, 谢彩霞. 髋部骨折病人跌倒恐惧的研究进展. 护理研究, 2022, 36(21): 3856-3859.
37. 尹航. 老年髋部骨折患者肌肉衰减症、营养状况与跌倒风险的相关性研究. 吉林延吉: 延边大学, 2020.
38. 孙敬博, 于潇, 张新玉, 等. 决策辅助对全髋关节置换术患者功能锻炼依从性的效果观察. 护理实践与研究, 2025, 22(4): 620-626.

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Latest ArticlesConstruction of intervention program for postoperative fear of falling in elderly patients with hip fracture based on cognitive behavioral theory

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