Efficacy of geriatric interdisciplinary home rehabilitation for patients with hip fracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
209 elderly patients undergoing rehabilitation for hip fracture were randomized to receive either Geriatric Interdisciplinary Home Rehabilitation (GIHR) or conventional geriatric care and rehabilitation. The purpose of this study was to compare the efficacy of GIHR and conventional care and rehabilitation in terms of walking ability and gait speed up to 1 year, and postoperative length of stay until discharge. All outcomes of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Medicine, Odontology, and Health, the Foundation of the Medical Faculty, the Swedish Dementia Foundation, and the Strategic Research Program in Care Sciences, Sweden
Conflicts: None disclosed
Why was this study needed now?
Elderly patients who suffer from hip fracture have frequently reported the loss of independence while performing activities of daily life (ADL) due to a permanent reduction of mobility and activity. To address this issue, many rehabilitative therapies for hip fracture patients have a special focus on early mobilization, exercise, and independence, including the Geriatric Interdisciplinary Home Rehabilitation (GIHR). Due to the lack of research investigating the efficacy of GIHR in elderly patients with cognitive impairment as well as those living In residential care facilities, the current study was warranted.
What was the principal research question?
For elderly patients in rehabilitation following hip fracture, was Geriatric Interdisciplinary Home Rehabilitation (GIHR) associated with significantly improved walking ability, walking speed, and postoperative length of hospital stay when compared to conventional geriatric care and rehabilitation?
Population: 209 patients (aged 70 years or older) who underwent acute hip fracture surgery due to cervical or trochanteric fracture were included between May 2008 and June 2011. Patients demonstrating cognitive impairment, or patients living in residential care facilities, were also screened for inclusion. All patients received interdisciplinary rehabilitation through comprehensive geriatric assessment (CGA), which consisted of early mobilization, occupational and physiotherapeutic training, and in-depth discharge planning.
Intervention: GIHR group: in addition to conventional CGA therapy, patients were also admitted into a multimodal rehabilitation program with a specialized aim of early hospital discharge and continuation of rehabilitation while at home (max. length = 10 weeks). Patients received a customized program based on participant’s postoperative goals through a cooperative team of health professionals (physiotherapist, occupational therapist, nurse, and geriatrician) (n=108, 80 completed follow-up; mean age= 83.2+/-7.0, 79F).
Comparison: CGA group: patients were admitted to a conventional rehabilitation program focusing on detection, prevention, and treatment of postoperative complications. Following discharge, patients who required additional therapy were referred to primary health care or to rehabilitative actions in their facilities (n=101, 79 completed follow-up; mean age= 82.6+/-6.4, 68F).
Outcomes: Outcomes of interest included walking ability (rated on a 7 point scale, where 1 indicates the requirement of two assistance or no functional ability, and 7 indicates normal function), the use of a walking device, gait speed over 2.4 meters, and postoperative length of hospital stay (LOS).
Methods: RCT
Time: Outcomes of interest were evaluated at baseline and after 3 and 12 months.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.