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Despite implementing hospital quality programs after hip fracture surgery older adults often experience a decline in the level of physical function, reduced quality of life; and the mortality and readmission rates are high.
Early mobilization is important in order to prevent loss of muscle mass; however to prevent morbidity an early start of strength training is also necessary. Furthermore, the risk of complications, morbidity, and mortality are associated with insufficient management of pain.
The project aims to examine the effect of measuring vital signs and consistent rehabilitation in the primary and secondary sectors in older adults after hip fracture surgery.
Method/ design:
The study is a cluster-randomized stepped wedge study. Participants will be recruited among patients admitted to an orthogeriatric ward who are 65 years of age or older and citizens in one of six municipalities. Participants are also the health professionals in the orthogeriatric ward and the six municipalities.
The six municipalities form six clusters, which are randomized, and every three-month one cluster cross from control to intervention.
The study compares usual practice (control) to an intervention named 'Rehabilitation of Life'. An intervention best described as an empowerment-oriented cross-sectorial program including vital sign measurement and systematic progressive rehabilitation and combined with convenient access for collaboration among professionals.
Primary outcomes: Timed Up and Go (TUG) measured 2 months after the time of operation.
The investigators hypothesize that 'Rehabilitation of Life' for older adults with a hip fracture will result in a significant reduced TUG-score in comparison to a practice not offering 'Rehabilitation of Life'.
And as the study is organised across two sectors, the Cumulated Ambulation Score (CAS) makes a second primary outcome. It is hypothesised that patients in the intervention group will achieve a significantly reduced TUG score compared to usual care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 'Rehabilitation for Life' | Experimental | Vital sign measurement and rehabilitation |
|
| Usual care and rehabilitation | Active Comparator | Usual care and rehabilitation provided in primary and secondary sectors |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 'Rehabilitation for Life' | Other | An empowerment-oriented cross-sectorial program including vital sign measurement and systematic progressive rehabilitation combined with convenient access for collaboration among professionals. |
| Measure | Description | Time Frame |
|---|---|---|
| Timed up and go | Measures functional mobility, as the time in seconds it takes a person to rise from a chair with arms, walk 3 m and return to the chair. A higher scores mean a worse outcome | Two months after the time of operation |
| Cumulated Ambulation Score (CAS) | Measures basic mobility. The score 0-6. Higher scores mean a better outcome | One months after the time of operation |
| Measure | Description | Time Frame |
|---|---|---|
| Timed up and go | Measures functional mobility, as the time in seconds it takes a person to rise from a chair with arms, walk 3 m and return to the chair. A higher scores mean a worse outcome | Three and six months after the time of operation |
| Barthel-20 |
| Measure | Description | Time Frame |
|---|---|---|
| Eq-5D | A standardised questionnaire used to assess the patients health-related quality of life and function | 2, 3, 6 and 12 months after the time of surgery |
| Mortality 30 days and 1 year. | Mortality |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Inge Bruun, post doc | The Region of Southern Denmark and University of Southern Denmark | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Inge Bruun | Kolding | Southern Denmark | 6000 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35526010 | Derived | Ipsen JA, Pedersen LT, Viberg B, Norgaard B, Suetta C, Bruun IH. Rehabilitation for life: the effect on physical function of rehabilitation and care in older adults after hip fracture-study protocol for a cluster-randomised stepped-wedge trial. Trials. 2022 May 7;23(1):375. doi: 10.1186/s13063-022-06321-w. |
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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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| ID | Term |
|---|---|
| D012046 | Rehabilitation |
| ID | Term |
|---|---|
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
| D013812 | Therapeutics |
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A cluster-randomized stepped wedge study. A design that is initiated with a period without interventions followed by a form of cross-over, in which each cluster systematic cross from control to intervention.
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| Usual care and rehabilitation | Other | The care and rehabilitation usual provided to patients after hip fracture surgery |
|
A validated tool used to assess the patient's need for help to perform acitivities of daily living |
| 2, 3, 6 and 12 months after the time of surgery |
| Mortality measured after 30 days and one year |
| Readmission | Readmission rate | Readmission measured 30 days after discharge |
| D007869 |
| Leg Injuries |
| D006296 |
| Health Services |
| D005159 | Health Care Facilities Workforce and Services |