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Every day, more than 40 Australian break their hip, Most are over the age of sixty five. Hip fractures are a significant problem for the older people, the hospital system and community as a whole because of the increasing numbers of fractures and the cost of hospitalisation and ongoing care. After one year, less than half of all people with a hip fracture can walk as well as they did before the fracture. Physiotherapy in the acute hospital setting is an integral part of patient care, although the intensity of physiotherapy a patient receives is variable and the optimal number of treatment sessions per day remains unknown. Studies in other patient groups have shown that increased physiotherapy can improve patient outcomes by increasing muscle strength and mobility. It can also reduce the negative effects of bed rest such as muscle wasting, blood clots in the lungs or leg veins and chest infections such as pneumonia. This study aims to investigate the effectiveness of an intensive physiotherapy program in hip fracture patients to further understand this and the effect it has on patient function.
In this research the investigators will randomly allocate patients into 2 groups; usual care and intensive physiotherapy. The usual care group will have physiotherapy treatment daily whereas the intensive physiotherapy group will have an additional daily treatment by a physiotherapist as well as a daily treatment by an allied health assistant. The objectives are to achieve better functional outcomes in the patient's hospital stay (ie improved mobility), reduce the time for patients to be physically ready to go home, increase the number of patients able to go directly home or to fast stream rehabilitation (rather than a slow stream option).
If increased intensity of physiotherapy is found to improve patient's mobility outcomes, this research will provide the confidence to endorse a change to current clinical practice.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual care | Active Comparator | usual care physiotherapy - once daily treatment whilst inpatient in acute hospital |
|
| Intensive physiotherapy | Experimental | additional once daily physiotherapy and once daily allied health assistant intervention |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intensive physiotherapy | Other | additional once daily physiotherapy and once daily allied health assistant intervention (equals two more treatments) whilst an inpatient in acute hospital |
| Measure | Description | Time Frame |
|---|---|---|
| modified IOWA Level of Assistance Scale | Functional score measuring 6 mobility domains | 5 days |
| Measure | Description | Time Frame |
|---|---|---|
| length of stay - acute and rehabilitation | the length of acute hospital stay and rehabilitation stay - until discharge home or to a long term facility | participants will be followed for duration of hospital stay - average one month |
| timed up and go |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lara A Kimmel, B.Physio | The Alfred | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Alfred | Melbourne | Victoria | 3181 | Australia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27456448 | Derived | Kimmel LA, Liew SM, Sayer JM, Holland AE. HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial. Med J Aust. 2016 Jul 18;205(2):73-8. doi: 10.5694/mja16.00091. |
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| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
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| Usual Care | Other | once daily physiotherapy whilst acute hospital inpatient |
|
| 5 days |
| Glasgow Outcomes Score -Extended | 6 months |
| discharge destination | discharge destination from the acute hospital - options include: home, fast stream rehabilitation, slow stream rehabilitation, long term facility | participants will be followed until discharge from the acute hospital - average 10 days |
| physical readiness for discharge | when a patient is deemed physically ready go home - eg can access their house and mobilise within house and outdoors | average one month |
| 12-Item Short Form Health Survey (SF-12) | 6 months |
| EuroQOL five dimensions questionnaire (EQ-5D) | 6 months |
| D007869 |
| Leg Injuries |