Early Coordinated Rehabilitation After Hip Fracture

NCT03301584 | Completed

• 1 other identifier: FoU in Sweden 62221
• Study Type: interventional
• Target: 126
• Locations: 1 country
• Sites: 1

Brief Summary

Background Studies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care (CGC) unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes. To our knowledge no study has been performed comparing rehabilitation programmes within a CGC unit during the acute phase after hip fracture with focus on improving patients' perceived participation and subsequent effect on patients' function. Method A prospective, controlled, intervention performed in a Comprehensive Geriatric Care (CGC) unit and compared with standard CGC. A total of 126 patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. Intervention Group (IG): 63 patients, mean age 82.0 years and Control Group (CG): 63 patients mean age 80.5 years. Intervention: coordinated rehabilitation programme with early onset of patient participation and intensified occupational therapy and physiotherapy after hip fracture surgery. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: TLS-BasicADL; Bergs Balance Scale (BBS); Falls Efficacy Scale FES(S); Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) at discharge and 1 month and ADL staircase for instrumental ADL at 1 month.

Conditions

Hip Fractures; Rehabilitation

Keywords

Hip fracture; ADL; patient participation; functional balance; physical performance

Outcome Measures

Primary Outcomes (1)

• Self-rated degree of patient participation in rehabilitation

  Patients answered 4 questions, specifically formulated for this study, regarding perceived level of participation in; their rehabilitation; working together with OT and PT in goal-setting; personal responsibility for their training, and making decisions regarding care and treatment as much as they liked. The questions were answered using a four level scale; very high degree, moderate degree, small degree or not at all.

  At discharge from in-patienten rehabilitation, on average 14 days

Secondary Outcomes (6)

• Traffic Light System - BasicADL (TLS-BasicADL)

  At discharge from in-patient rehabilitation, on average 14 days and 1 month follow-up

• ADL Staircase

  At 1 month follow-up

• Bergs Balance Scale (BBS)

  At discharge from in-patient rehabilitation, on average 14 days and 1 month follow-up

• Falls Efficacy Scale (FES-S)

  At discharge from in-patient rehabilitation, on average 14 days and 1 month follow-up

• Short Physical Performance Battery (SPPB)

  At discharge from in-patient rehabilitation, on average 14 days and 1 month follow-up

Study Arms (2)

Enhanced collaboration

ACTIVE COMPARATOR

Enhanced OT and PT collaboration to promote patient participation. Goal setting using TLS-BasicADL protocol. Patients were encouraged to consider activities important to them to be able to perform at discharge. Adaption of goals throughout the hospital stay. Supporting patient self-efficacy: by challenging patients' fear of falling and encouraging progression of exercise. Training kit with instructions: To increase activity and encourage patients to take more responsibility for their training. Enhanced exercise with protocol: More intensive training of transfers, walking, balance and P-ADL was offered at least 3 times/day by OT and PT. Collaboration meetings: twice weekly interdisciplinary meetings plus daily OT and PT logistic meeting to schedule treatment.

Other: Enhanced collaboration to promote patient participation

Usual Care Treatment

ACTIVE COMPARATOR

Standard rehabilitation

Other: Usual Care treatment

Interventions

Enhanced collaboration to promote patient participation OTHER

Enhanced OT and PT collaboration: to promote patient participation. Goal setting using TLS-BasicADL protocol. Patients were encouraged to consider activities important to them to be able to perform at discharge. Adaption of goals throughout the hospital stay. Supporting patient self-efficacy: by challenging patients' fear of falling and encouraging progression of exercise. Training kit with instructions: To increase activity and encourage patients to take more responsibility for their training. Enhanced exercise with protocol: More intensive training of transfers, walking, balance and P-ADL was offered at least 3 times/day by OT and PT. Collaboration meetings: twice weekly interdisciplinary meetings plus daily OT and PT logistic meeting to schedule treatment.

Enhanced collaboration

Usual Care treatment OTHER

The control group received standard rehabilitation from occupational therapists and physiotherapists (Monday to Friday), planned individually and gradually progressed for each patient. Mobilisation was initiated within 24 hours after surgery, 7 days a week. Patients were provided with a booklet with information about the fracture, operation method, exercise regime and assistive walking and ADL aid available.

Usual Care Treatment

Eligibility Criteria

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

You may qualify if:

• presenting with acute hip fracture
• aged 65 or more
• able to speak and understand Swedish
• community dwelling pre-fracture
• independent walking indoors with or without walking aid and in personal care with exception of bathing/showering.

You may not qualify if:

• severe drug or alcohol abuse
• mental illness
• documented cognitive impairment ≤ 8 according to the Short Portable Mental Status Questionnaire (SPMSQ)

Sponsors & Collaborators

• Göteborg University: lead
• Axel Linders Stiftelse: collaborator
• SKLs' äldresatsning: collaborator
• Local Research and Development Fund in Gothenburg and South Bohuslän: collaborator
• Sahlgrenska University Hospital: collaborator

Study Sites (1)

Sahlgrenska University Hospital, Mölndal Hospital

Mölndal, 43180, Sweden

Location

Related Publications (2)

• Handoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2021 Nov 12;11(11):CD007125. doi: 10.1002/14651858.CD007125.pub3.

  PMID: 34766330 DERIVED

• Asplin G, Carlsson G, Ziden L, Kjellby-Wendt G. Early coordinated rehabilitation in acute phase after hip fracture - a model for increased patient participation. BMC Geriatr. 2017 Oct 17;17(1):240. doi: 10.1186/s12877-017-0640-z.

  PMID: 29041916 DERIVED

MeSH Terms

Conditions

Hip Fractures; Patient Participation

Condition Hierarchy (Ancestors)

Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries; Patient Acceptance of Health Care; Treatment Adherence and Compliance; Health Behavior; Behavior

Study Officials

• Lena Zidén, PhD

  Göteborg University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: A prospective, controlled, intervention study. Evaluation of a modified model of in-patient rehabilitation compared to standard care, with follow-up at 1 month post-discharge.

Study Record Dates

• First Submitted: September 22, 2017
• First Posted: October 4, 2017
• Study Start: September 1, 2013
• Primary Completion: June 30, 2014
• Study Completion: June 30, 2014
• Last Updated: January 6, 2020

Record last verified: 2020-01

Locations

SE (1)