Care Pathway for Sub-acute Hip Rehabilitation

Not Applicable

Completed

• Conditions: Hip Fractures
• Interventions: Other: Care Pathway

• Registration Number: NCT03906864
• Lead Sponsor: St Luke's Hospital, Singapore

Brief Summary

The effectiveness of integrated care pathways for hip fractures in sub-acute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a sub-acute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. A randomised controlled trial on an integrated care pathway was conducted for hip fracture patients in a sub-acute rehabilitation setting. The study supports the use of integrated care pathways in sub-acute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.

Detailed Description

All patients admitted to St Luke's Hospital, a 185-bed hospital in Singapore providing multidisciplinary stepdown care, from 8 September 2004 to 14 June 2006 for the purpose of rehabilitation after a new hip fracture were included. Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial. Administrative staff allocated patients to either ICP or usual care according to the last digit of their National Registration Identity Card (NRIC) numbers, odd numbers to the intervention group and even numbers to the control group. Patients were then admitted to 1 of 2 intervention wards or 1 of 3 control wards. Patients were enrolled by the principal investigators only after moving into their respective wards because of work flow limitations. Those who refused consent or were excluded remained in their assigned wards and received usual care. Both intervention and control groups were under the care of multidisciplinary teams but the intervention group had structured assessments and checklists in addition to usual care while the control group had usual care alone.

Study Timeline

• Study Start: 2004-09-08
• Primary Completion: 2006-06-14
• Study Completion: 2012-12-26
• Study First Submitted: 2018-09-16
• Status Verified: 2019-04
• Study First Submitted QC: 2019-04-05
• Last Update Submitted: 2019-04-05
• Study First Posted: 2019-04-08
• Last Update Posted: 2019-04-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 162

Inclusion Criteria

• Patients admitted to St Luke's Hospital for the purpose of rehabilitation after a new hip fracture.

Exclusion Criteria

• Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention group	Care Pathway	Intervention group had structured assessments and checklists (as part of the integrated care pathway) in addition to usual care.

Primary Outcome Measures

Name	Time	Method
Length of stay in hospital	1 day At discharge	Refers to the average number of days that patients spend in hospital
Montebello Rehabilitation Factor Score (MRFS)	At 1 year	MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100)
Proportions of patients achieving pre-morbid ambulatory status	At 1 year	Pre-morbid ambulatory status is a predictor for post-operative mobility
Percentage of patients admitted to nursing home	Up to 1 year after discharge	A form of institutional care

Secondary Outcome Measures

Name	Time	Method
Cumulated mortality	1 year	Probability or risk of individuals dying from the disease during a specified period
Quality of life scale-Short form 12 quality of life	6 months and 1 year	Scale for short form 12 quality of life 0-100; Scale for Physical Component Summary (PCS) and Scale for Mental Component Summary (MCS), a multipurpose, generic measure of health status 0-100; Interpretation of the score : The higher score, the better
Readmissions to an acute hospital for any reason	up to 1-year post-discharge	An episode when a patient who had been discharged from a hospital is admitted again within a specified time interval

Trial Locations

Locations (1)

St Luke's Hospital, Singapore; 🇸🇬 Singapore, Singapore