Early Coordinated Rehabilitation in Acute Phase After Hip Fracture - a Model for Increased Patient Participation.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 126
- 试验地点
- 2
- 主要终点
- Self-rated degree of patient participation in rehabilitation
研究概览
简要总结
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.
详细描述
At Sahlgrenska University Hospital patients with hip fracture are treated from admission to discharge in a CGC. To our knowledge no study has been performed within a CGC unit to compare rehabilitation programmes during the acute phase after hip fracture with focus on improving patients' perceived participation and the effect on patients' function.
The primary aim was therefore to evaluate a modified programme of coordinated inpatient rehabilitation during the acute phase after hip fracture surgery with focus was on patients' perceived participation. Secondary aims were to investigate effect on activities of daily living, functional balance and confidence and physical performance. A further aim was to investigate level of recovery at 1 month follow-up including risk for future falls.
Method Study design A prospective, controlled, intervention study. Evaluation of in-patient rehabilitation with follow-up at 1 month post-discharge.
Setting and Participants This study was performed in a CGC unit, at Sahlgrenska University Hospital in Gothenburg, Sweden comprising three wards, with a total of 78 beds. During September 2013 and May 2014, a convenience sample of 126 patients with hip fracture was recruited. Patients were admitted to one of the three wards depending on available beds. One ward was allocated as the intervention ward and the other two as controls.
Comprehensive Geriatric Care (CGC) All three geriatric wards follow a structured, systematic interdisciplinary geriatric care pathway for hip fracture patients, commencing at admission pre-operatively through to discharge. This follows a fast track approach including; assessment and management of the patient's somatic and mental health, physical function, ADL ability, social situation, early mobilisation/rehabilitation and early discharge planning. While orthopaedic surgeons are responsible for surgical fixation of the patients' fracture and routine examination of X-rays after the patient has been weight-bearing, patients are admitted to and cared for throughout their hospital stay by the interdisciplinary team on the geriatric ward.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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.
排除标准
- •severe drug or alcohol abuse
- •mental illness
- •documented cognitive impairment ≤ 8 according to the Short Portable Mental Status Questionnaire (SPMSQ)
结局指标
主要结局
Self-rated degree of patient participation in rehabilitation
时间窗: At discharge from in-patienten rehabilitation, on average 14 days
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.
次要结局
- Timed Up and Go (TUG)(At discharge from in-patient rehabilitation, on average 14 days and 1 month follow-up)
- 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)