File
Karlsson Å1, Berggren M2, Lindelöf N1, Englund U2, Olofsson B3, Nordström P2, Gustafson Y2, Stenvall M2
1Umeå University, Community Medicine and Rehabilitation, Unit of Geriatric Medicine and Physiotherapy, Umeå, Sweden, 2Umeå University, Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå, Sweden, 3Umeå University, Department of Nursing and Department of Surgical and Perioperative Sciences, Umeå, Sweden
Background: The evidence for geriatric team rehabilitation after hip fracture in the home setting are still limited. Few studies describes complications after discharge and the effects on dependence in Activities of Daily Living (ADLs) have been conflicting. Above all, previous studies have not included people with severe cognitive impairment or dementia, those with serious medical conditions and/or those living in residential care facilities, groups that represents a large proportion of people with hip fracture. We have previously shown that interdisciplinary home rehabilitation reduced length of stay in hospital with a median of 6 days and participants in home rehabilitation group regained walking ability similar to the control group.
Purpose: To evaluate the effects of geriatric interdisciplinary home rehabilitation for people with hip fracture on ADLs, complications, readmissions and total days spent in hospital during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.
Methods: A randomized controlled trial in a geriatric ward, in ordinary housing and in residential care facilities among people with acute hip fracture, aged 70 or older, and living in the north of Sweden. The intervention aimed at early discharge, individually designed home rehabilitation and on prevention, detection and treatment of complications after discharge. Blinded assessors measured dependence in ADLs (Barthel ADL-index, The Staircase of ADL) during hospital stay and at the 3- and 12 month follow-up in the participants´ homes. Complications, readmissions and days in hospital were registered after study completion using patients´ digital records and follow-up data. Binary logistic regression models were used to analyze odds ratios of independence in The Staircase of ADL and the risk of falling after discharge according to group allocation.
Results: Totally, 205 participants were included, 107 in home rehabilitation group and 98 in control group. In preliminary analyses, the groups recovered their pre-fracture ability of performing ADLs comparably. At 12 months, 33 (41.3%) vs 33 (41.8%) in home rehabilitation and control group respectively (p=1.000) had regained or improved their pre-fracture ADL performance according to the Barthel ADL-index and 27 (37.0%) vs 36 (48.6%) according to the Staircase of ADL (p=0.207). The proportions of complications, readmissions and days in hospital between discharge and 12 month follow-up did not differ between groups. Among participants in home rehabilitation group 57 (53.8%) vs control group 44 (47.3%) had complications (p=0.443), 46 (43.4%) vs 38 (40.9%) fell (p= 0.828), and 38 (35.8%) vs 27 (29.0%) were readmitted to hospital (p= 0.383).
Conclusion(s): Despite 6 days shorter initial length of stay in hospital, the home rehabilitation group seemed to regain performance in ADLs comparably and had the same amount of complications, readmissions and days in hospital after discharge compared with conventional geriatric care and rehabilitation. The intervention seemed feasible for the whole group of people with hip fracture.
Implications: Team based home rehabilitation, in which the physiotherapist is an essential team member, seems to be as effective as conventional geriatric care and rehabilitation and should be considered also for people with severe cognitive impairment and for those living in residential care facilities.
Keywords: Hip fracture, home rehabilitation, patient care team
Funding acknowledgements: Umeå University and County Council (Västerbotten), Foundation of Medical Faculty, Swedish Dementia Association, Strategic Research Program in Care Sciences (Sweden)
Purpose: To evaluate the effects of geriatric interdisciplinary home rehabilitation for people with hip fracture on ADLs, complications, readmissions and total days spent in hospital during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.
Methods: A randomized controlled trial in a geriatric ward, in ordinary housing and in residential care facilities among people with acute hip fracture, aged 70 or older, and living in the north of Sweden. The intervention aimed at early discharge, individually designed home rehabilitation and on prevention, detection and treatment of complications after discharge. Blinded assessors measured dependence in ADLs (Barthel ADL-index, The Staircase of ADL) during hospital stay and at the 3- and 12 month follow-up in the participants´ homes. Complications, readmissions and days in hospital were registered after study completion using patients´ digital records and follow-up data. Binary logistic regression models were used to analyze odds ratios of independence in The Staircase of ADL and the risk of falling after discharge according to group allocation.
Results: Totally, 205 participants were included, 107 in home rehabilitation group and 98 in control group. In preliminary analyses, the groups recovered their pre-fracture ability of performing ADLs comparably. At 12 months, 33 (41.3%) vs 33 (41.8%) in home rehabilitation and control group respectively (p=1.000) had regained or improved their pre-fracture ADL performance according to the Barthel ADL-index and 27 (37.0%) vs 36 (48.6%) according to the Staircase of ADL (p=0.207). The proportions of complications, readmissions and days in hospital between discharge and 12 month follow-up did not differ between groups. Among participants in home rehabilitation group 57 (53.8%) vs control group 44 (47.3%) had complications (p=0.443), 46 (43.4%) vs 38 (40.9%) fell (p= 0.828), and 38 (35.8%) vs 27 (29.0%) were readmitted to hospital (p= 0.383).
Conclusion(s): Despite 6 days shorter initial length of stay in hospital, the home rehabilitation group seemed to regain performance in ADLs comparably and had the same amount of complications, readmissions and days in hospital after discharge compared with conventional geriatric care and rehabilitation. The intervention seemed feasible for the whole group of people with hip fracture.
Implications: Team based home rehabilitation, in which the physiotherapist is an essential team member, seems to be as effective as conventional geriatric care and rehabilitation and should be considered also for people with severe cognitive impairment and for those living in residential care facilities.
Keywords: Hip fracture, home rehabilitation, patient care team
Funding acknowledgements: Umeå University and County Council (Västerbotten), Foundation of Medical Faculty, Swedish Dementia Association, Strategic Research Program in Care Sciences (Sweden)
Topic: Older people; Disability & rehabilitation
Ethics approval required: Yes
Institution: Umeå University
Ethics committee: Regional Ethical Review board, Umeå
Ethics number: DNR 08-053M
All authors, affiliations and abstracts have been published as submitted.
