OBJECTIVES: To examine whether self-efficacy mediated the effect of the Home-based Post-Hip Fracture Rehabilitation program on activity limitations in older adults after hip fracture and whether the mediating effect was different between sex and age groups. DESIGN: Randomized controlled trial. SETTING: Community. PARTICIPANTS: Participants with hip fracture (n = 232; mean age +/- SD 79 +/- 9.4y) were randomly assigned to intervention (n = 120, 51.7%) and attention control (n = 112, 48.3%) groups. INTERVENTIONS: The 6-month intervention, the Home-based Post-Hip Fracture Rehabilitation, is a functionally oriented, home-based exercise program. Data were collected at baseline, postintervention (6 mo), and follow-up (9 mo). MAIN OUTCOME MEASURES: Activity Measure for Post-Acute Care. RESULTS: The mediating effect of the Home-based Post-Hip Fracture Rehabilitation program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (beta-indirect = 0.21). Similarly, the mediating effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (beta-indirect = 0.49). In subgroup analyses, the mediating effect was significant at 9 months in the younger group (age < 79 y) in comparison to the older group and was significant in women in comparison to men. CONCLUSIONS: Self-efficacy may play a partial mediating role in the effect on some longer-term functional outcomes in the Home-based Post-Hip Fracture Rehabilitation intervention. The results suggest that program components that target self-efficacy should be incorporated in future hip fracture rehabilitation interventions. Age and sex of the targeted participants may also need to be considered when developing interventions.

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