An Inpatient Rehabilitation Model of Care Targeting Patients With Cognitive Impairment

NCT01566136 | Completed Phase 2

• 1 other identifier: CIHR DPA-93049
• Study Type: interventional
• Target: 198
• Locations: 1 country
• Sites: 1

Brief Summary

Hip fractures are a danger to an individual's mobility, independence and ability to live in the community. When patients have a cognitive impairment (such as dementia or delirium) they do not recover as well or go back to their homes as often as those patients who do not have a cognitive impairment. Therefore, our team developed a rehabilitation model to care for patients with hip fractures, and specifically for those patients with CI. The model of care is called the Patient Centred Rehabilitation Model of Care (PCRM-CI). This 3 year study will focus on comparing the new model with usual rehabilitation care. This study will also focus on understanding the factors that could influence the use of the model on new rehabilitation units. The investigators hypothesize that patients who have received the new model of care will have better mobility outcomes over time. The investigators will collect data in 2 hospitals, 70 patients receiving the usual care and 70 patients receiving the care in the new model. The team will invite 60 staff and their unit managers as well. This study will help decision makers to use research findings to make better decisions about care of older Canadians.

Conditions

Hip Fracture

Keywords

hip fracture patients; cognitive impairment; rehabilitation model of care

Outcome Measures

Primary Outcomes (1)

• Change from baseline in mobility at 6 months

  Baseline to 6 months post-surgery

Secondary Outcomes (1)

• Change from baseline in physical functioning at 6 months

  Baseline to 6 months post-surgery

Study Arms (2)

Usual care

NO INTERVENTION

Current routine rehab care for persons with a hip fracture and CI lacks a well integrated care system within the local hospital network. The usual approach to care at the two sites differ in one major way: patients presenting with a hip fracture to Site 1 receive surgery locally, while those presenting to Site 2 receive surgery at a different hospital because of the absence of an operating suite at this site. Within 2 to 10 days 95% of patients presenting to either site hospital's emergency room with a hip fracture, receive internal fixation or arthroplasty surgery. Patients, including some with mild and moderate CI, are then transferred to in-patient rehabilitation beds at Site 1 or Site 2. Screening of patients for dementia or delirium is not routinely done.

Rehabilitation Model of Care

EXPERIMENTAL

Staff will be introduced to five components of the Patient-Centred Rehabilitation Model of Care (PCRM-CI) in a one-day workshop prior to implementing the PCRM-CI model. They will then be provided with eight additional educational sessions throughout the year. A manual detailing all aspects of training, including specifics on how to present the material, ideas for stimulating discussion, and case vignettes to illustrate training concepts was developed for our pilot study and will be used here. We also produced a short video on care of elderly with CI in rehabilitation which will be utilized in the training session. The model will be tested over a one year period with a sustainability plan in place developed by the local hospital network and the two study sites.

Behavioral: Rehabilitation Model of Care

Interventions

Rehabilitation Model of Care BEHAVIORAL

The PCRM-CI model includes the following 5 components: rehabilitation management; dementia management; delirium prevention and management; staff education and support; and family/significant other support and education.

Also known as: Patient Centred Rehabilitation Model of Care

Rehabilitation Model of Care

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• years or older,
• admitted to rehabilitation directly from an acute care hospital after receiving surgery for a hip fracture
• living in the community, home or residential setting (where an individual has services and supports but does not require 24 hour nursing care) prior to sustaining the hip fracture,
• able to speak and understand English
• have a family member or close friend who is familiar with the patients' pre-fracture condition and can act as a collateral informant.

You may not qualify if:

• they have a pathologic hip fracture
• the hip fracture is associated with multiple trauma
• they have had a previous hip fracture.

Sponsors & Collaborators

• University Health Network, Toronto: lead

Study Sites (1)

Northumberland Hospital

Cobourg, Ontario, Canada

Location

Related Publications (2)

• McGilton KS, Davis AM, Naglie G, Mahomed N, Flannery J, Jaglal S, Cott C, Stewart S. Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr. 2013 Dec 13;13:136. doi: 10.1186/1471-2318-13-136.

  PMID: 24330470 DERIVED

• McGilton KS, Davis A, Mahomed N, Flannery J, Jaglal S, Cott C, Naglie G, Rochon E. An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr. 2012 May 25;12:21. doi: 10.1186/1471-2318-12-21.

  PMID: 22631877 DERIVED

MeSH Terms

Conditions

Hip Fractures; Cognitive Dysfunction

Condition Hierarchy (Ancestors)

Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries; Cognition Disorders; Neurocognitive Disorders; Mental Disorders

Study Officials

• Katherine S McGilton, PhD

  UHN-Toronto Rehab

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 21, 2012
• First Posted: March 29, 2012
• Study Start: August 1, 2009
• Primary Completion: March 1, 2014
• Study Completion: March 1, 2014
• Last Updated: April 24, 2014

Record last verified: 2014-04

Locations

CA (1)