Adherence to Home-Based Rehabilitation in Older Adults With Diabetes After Hip Fracture Wen-Yu Kuo ▼ Yea-Ing Lotus Shyu ▼ Jong-Shyan Wang ▼ Min-Chi Chen ▼ Chi-Chuan Wu ▼ Mei-Ling Chen Abstract: Background: Adherence to rehabilitation is beneficial to patients with hip fracture. However, the relationships between different levels of adherence and postoperative recovery among older adults after hip fracture have not been addressed thoroughly in the literature. Objectives: The aims of this study were to explore the trajectories of adherence to home-based rehabilitation during the 12-month period after hospital discharge and to examine the effects of adhering to prescribed home-based rehabilitation on postoperative recovery of physical functions. Methods: We employed a secondary data analysis, and 88 hip-fractured older adults with diabetes were recruited. The Chinese Barthel Index was used to measure daily physical functions, a goniometer was used to measure range of motion, and the MicroFET2 dynamometer was used to measure muscle power. Adherence was measured as the rate of adherence to the suggested frequency of home-based rehabilitation activities. Results: Adherence to home-based rehabilitation decreased over time. The high-adherence group was more likely to recover prefracture physical functions than was the low-adherence group, and the high-adherence group had better self-care abilities, greater range of motion for ankle extension, and higher muscular strength on both adduction and abduction than did the low-adherence group. Discussion: The results of our study suggest that patients adhere to more than 50% of prescribed rehabilitation. Future studies should continue to explore interventions to enhance rehabilitation adherence after hospital discharge. Key Words: adherence  diabetes mellitus  hip fracture  home-based rehabilitation  older adults  secondary analysis Nursing Research, September/October 2019, Vol 68, No 5, 383–389 H ip fracture has severe negative consequences on the overall health of older adults and has become a major health issue worldwide (Peeters et al., 2016). It is also associated with increased mortality—particularly in the first year following surgery (Mundi, Pindiprolu, Simunovic, & Bhandari, 2014). Compared with nondiabetic controls, older adult patients with diabetes mellitus (DM) who experience hip fracture have significantly higher rates of mortality and hospital readmission and show impaired walking ability recov- ery and various other physical health outcomes (Y. F. Huang et al., 2012; Lieberman, Friger, & Lieberman, 2007). The prog- nosis of older adults with hip fracture has become an increas- ingly important concern for healthcare providers worldwide. The World Health Organization (2003) defines adherence as the degree to which an individual’s behavior—such as med- ication use, dietary control, or lifestyle changes—matches the suggestions of healthcare professionals. Adherence to therapy has been identified as the primary determinant of therapeutic success. Poor adherence mitigates the beneficial effects of clin- ical treatment and decreases the overall effectiveness of health- care systems (World Health Organization, 2003). Studies have found that high adherence is associated with improved health outcomes. For example, higher medication adherence was associated with lower mortality for patients with acute myo- cardial infarction (Rasmussen, Chong, & Alter, 2007). Another study found that a 10% increase in medication adherence for patients with DM decreased annual healthcare expenditures by 8.6% (Balkrishnan et al., 2003). Increased adherence to car- diac rehabilitation programs reduced hospital readmission rates and mortality (Alter, Zagorski, Marzolini, Forhan, & Oh, 2015; Martin et al., 2012). Although the literature supports the association between high adherence and good health Wen-Yu Kuo, PhD, RN, is Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan. Yea-Ing Lotus Shyu, PhD, RN, FAAN, is Professor, School of Nursing, College of Medicine and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Research Fellow, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Consultant, Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan. Jong-Shyan Wang, PhD, is Professor, Department of Physical Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Min-Chi Chen, PhD, is Professor, Department of Public Health and Biostatistics, Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Chi-Chuan Wu, MD, is Professor, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. Mei-Ling Chen, PhD, RN, is Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Professor, Department of Nurs- ing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan; Researcher, Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/NNR.0000000000000371 Nursing Research www.nursingresearchonline.com 383 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.