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BMC Geriatrics
Published in: BMC Geriatrics 1/2017

Open Access 01-12-2017 | Research Article

Early coordinated rehabilitation in acute phase after hip fracture – a model for increased patient participation

Authors: Gillian Asplin, Gunnel Carlsson, Lena Zidén, Gunilla Kjellby-Wendt

Published in: BMC Geriatrics | Issue 1/2017

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Abstract

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.

Methods

A prospective, controlled, intervention performed in a CGC unit and compared with standard care. 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.

Results

At discharge a statistically significant greater number of patients in the IG reported higher levels of participation (p < 0.05) and independence in lower body hygiene (p < 0.05) and dressing (p < 0.001). There were however no statistically significant differences at discharge and 1 month between groups in functional balance and confidence, performance measures or risk for falls.

Conclusion

This model of OT and PT coordinated inpatient rehabilitation had a positive effect on patients’ perceived participation in their rehabilitation and ADL at discharge but did not appear to affect level of recovery or risk for future falls at 1 month. A large proportion of patients remained at risk for future falls at 1 month in both groups highlighting the need for continued rehabilitation after discharge.

Trial registration

ClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4th October 2017).
Appendix
Available only for authorised users
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Metadata
Title
Early coordinated rehabilitation in acute phase after hip fracture – a model for increased patient participation
Authors
Gillian Asplin
Gunnel Carlsson
Lena Zidén
Gunilla Kjellby-Wendt
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0640-z

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