Objective: The objective of this study is to investigate whether home assessment visits prior to hospital discharge for patients recovering from hip fracture reduce falls and prevent hospital readmissions, within the first 30 days and six months after discharge home. Design: A randomized controlled trial was conducted. Setting: The study setting included hospital wards and the community. Participants: The study included adults 50 years and over recovering from hip fracture (n = 77). Intervention: Both groups received inpatient rehabilitation and hospital-based discharge planning. In addition, the intervention group received a home assessment visit by an occupational therapist prior to discharge from hospital. Main measures: Primary outcomes were falls and hospital readmissions. Secondary outcome measures included Functional Independence Measure, Functional Autonomy Measurement Scale, Nottingham Extended Activities of Daily Living Scale, EuroQol five dimension scale questionnaire and Falls Efficacy Scale-International. Results: The intervention group had fewer hospital readmissions in the first 30 days compared to the control group (intervention n = 1, control n = 10; odds ratio (OR) 12.9, 95% confidence interval (CI) 1.5 to 99.2). The intervention group was observed to have fewer falls than controls in the 30 days after discharge (intervention n = 6, control n = 14; incidence rate ratio (IRR) = 0.41, 95% CI 0.15 to 1.11). Between-group differences favoured the intervention group for functional independence at six months (11.2 units, 95% CI 4.2 to 18.2). There were no other between-group differences. Conclusion: Home assessment visits by occupational therapists prior to hospital discharge for patients recovering from hip fracture reduced the number of readmissions to hospital, increased functional independence at six months and may have reduced the risk of falls in the first 30 days after discharge.

There is low-to-moderate quality evidence that pre-discharge home assessment visits reduce patients' risk of falling and increase participation. The risk of readmission to hospital is also reduced, but not for patients following stroke.

Smart technology is increasingly accessible and provides a novel, convenient way to provide home exercise programs post stroke with a number of benefits. This technology is not for everyone, but may be well suited to patients who already own and use these devices in daily life. Automated reminders were not viewed as a useful reminder tool.

IntroductionAs part of hospital discharge planning, occupational therapists often provide recommendations to improve the interaction between a person and their home environment. The aim of this study was to investigate the number and type of recommendations made by occupational therapists during a home assessment visit compared to hospital‐based assessment for patients recovering from hip fracture. A secondary aim was to explore adherence rates to the different types of recommendations.MethodsProcess evaluation of a randomised controlled trial of 65 participants recovering from hip fracture, returning to community living after hospital discharge. All participants received inpatient multidisciplinary rehabilitation and hospital‐based assessment by an occupational therapist (usual care). In addition, the intervention group participated in a single home visit with an occupational therapist prior to hospital discharge. Analysis included the number and type of occupational therapy recommendations, adherence to recommendations at 30 days after discharge, and mediation analysis.ResultsParticipants in the home visit group received more recommendations than the usual care group (mean difference [MD] 2.8, 95% CI 1.6 to 3.9) and adhered to a greater proportion of recommendations for assistive technologies (MD 11.4%, 95% CI 2.6 to 20.2) and task modifications (MD 10.0%, 95% CI 0.7 to 19.3). Participants in both groups had lower rates of adherence to recommendations for home modifications compared with other types of recommendations. Adherence to recommendations was a mediator in the relationship between participants' involvement in a pre‐discharge home visit and reduced hospital readmissions.ConclusionThere was greater adherence to occupational therapy recommendations when patients recovering from hip fracture participated in a home visit compared to hospital‐based assessment, contributing to reduced readmissions to hospital in the first 30 days. Home visits offer additional benefits to hospital‐based assessment through the use of a collaborative approach to decision making in the home environment.

BackgroundReducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service.Methods/DesignA randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial.DiscussionThis paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services.Clinical trial registration numberAustralian and New Zealand Clinical Trials Registry ACTRN12609000973213

About one in four people admitted to hospital from a private residence following hip fracture receive a home visit. The results suggest that whether or not a patient receives a home visit has little to do with socio-demographic or clinical factors at the time of admission to hospital. There remains much unexplained variation in whether or not a patient receives a home visit and this study highlights the diversity that exists in clinical practice.

Introduction: The aim of this study was to determine the rate of readmission to hospital after hip fracture. The relationship between readmission to hospital and a range of social and functional variables, including receiving a home visit by an occupational therapist prior to discharge from hospital, was explored. Method: A retrospective cohort study was conducted of 154 patients returning to community living following hip fracture. Multivariate logistic regression identified variables associated with risk of readmission to hospital. Results: One in three patients was readmitted to hospital within 12 months after discharge, with 7% readmitted within 30 days. The most common reason for readmission was another fall. A low level of mobility prior to hip fracture was the strongest independent predictor of risk of readmission to hospital. There was no association between receiving a pre-discharge home visit by an occupational therapist and risk of readmission to hospital. Conclusion: Rates of readmission to hospital are high after hip fracture, and falls are the single most common reason for readmission. Interventions provided by occupational therapists, including home visits, should emphasise and incorporate evidence-based falls prevention strategies.

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