This study aimed to examine the effect of a multidisciplinary tele-rehabilitation program on functional recovery of older adults with hip fracture compared with home-based in-person rehabilitation. In this single-blinded, non-randomized clinical trial, we included older with hip fracture. The tele-rehabilitation group received a 12-week tele-rehabilitation program (supervised by their family caregivers). The control group received the usual postoperative rehabilitation provided by the Andalusian health system (Spain). The primary outcome was the patient-reported functional status assessed with the Functional Independence Measure. We also measured performance-based functional recovery using the Timed Up and Go Test and Short Physical Performance Battery. We performed both a per-protocol (62 participants; 28 tele-rehabilitation and 34 control groups) and an intention-to-treat analysis (71 participants; 35 tele-rehabilitation and 36 control groups). Participants who used the tele-rehabilitation program had higher Functional Independence Measure scores (high effect size: 0.98 Cohen’s d; p < 0.001) and better performance in the Timed Up and Go Test (medium effect size: 0.63 Cohen’s d; p = 0.025) compared with the control group. Differences between groups post-intervention were not statistically significant in the Short Physical Performance Battery. The tele-rehabilitation intervention proposed in this study is a valuable treatment option in the recovery process for older adults with hip fracture. ClinicalTrials.gov Identifier: NCT02968589.

The main caregiver is predominantly female and is most often the daughter of the patient. New treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden. Implications for rehabilitation The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing her burden of care should be included as one of the objectives of rehabilitation treatment. The caregivers of hip fracture patients must be considered as part of the treatment during the patient's recovery period, and patient handling training should be provided to the caregivers of hip fracture patients during the hospital stay to prepare the process of going back home. The caregivers of older patients, those with a low pre-fracture functional level, and of those who suffered post-operative complications, should receive more attention prior to hospital discharge and receive more assistance at home to reduce caregiver burden.

Home‐based tele‐rehabilitation programs are under development and may be a future option for some patients. The objectives of this non‐randomized clinical trial are to design a home‐based multidisciplinary tele‐rehabilitation protocol for patients with hip fracture, and to compare this protocol versus the home‐based usual outpatient rehabilitation protocol. Seventy patients treated for an acute hip fracture, aged 65 years or older, with a high pre‐fracture functional level (Functional Independence Measure score >90), without severe cognitive impairment, absence of terminal disease, discharged to their own home or a relativés home postoperatively, allowed weight‐bearing, and with signed informed consent, will be allocated into a tele‐rehabilitation group (n = 35) or a control group (n = 35). The inclusion criterion for the intervention group will be to have a caregiver with the ability to access the Internet who is willing to perform exercises and activities with the patient at home. The intervention includes a program of physical exercise and occupational therapy (five weekly sessions during 12 weeks), and recommendations for patients and their caregivers, all delivered through a website. The patient's functional level (Functional Independence Measure), quality of life (Euro‐Qol), physical performance (Timed Up and Go), caregiver burden (Zarit Interview), and other descriptive data will be assessed at hospital discharge, 4 weeks, and 12 weeks. This project will add to the knowledge concerning the feasibility of tele‐rehabilitation as an option to promote recovery of the pre‐fracture functional level for some patients with a hip fracture. http://ClinicalTrials.gov Identifier: NCT02968589NCT.

Objective To explore family caregivers’ perspectives of the recovery process of older adults with hip fracture, and describe experiences from caregivers who (i) used the online intervention or (ii) received home-based care provided by the Andalusian Public Health Care System. Methods This was an exploratory secondary study with informal family caregivers who had an older adult family member with hip fracture enrolled in a novel telerehabilitation (telerehab) clinical trial. Forty-four caregivers of older adults with hip fracture were interviewed at 6 to 9 months after their family member’s hip fracture. Results Caregivers shared concerns of family members’ survival and recovery; they recounted increased stress and anxiety due to the uncertainty of new tasks associated with providing care and the impact on their lifestyle. Although most caregivers were satisfied with the health care received, they made suggestions for better organization of hospital discharge, and requests for home support. The main reasons why caregivers and their family member chose the telerehab program were to, enhance recovery after fracture, gain knowledge for managing at home, and the convenience of completing the exercises at home. There were more family caregivers in the control group who expressed a high level of stress and anxiety, and they also requested more social and health services compared with caregivers whose family member received telerehab. Conclusions Family caregivers are an essential component of recovery after hip fracture by providing emotional and physical support. However, future clinical interventions should evaluate person-centered interventions to mitigate possible stress and anxiety experienced by family caregivers. Impact Family caregivers’ perspectives are necessary in the co-design of management strategies for older adults after hip fracture.

To translate the Cumulated Ambulation Score (CAS) into Spanish (CAS-E) and to examine the interrater reliability and agreement of the CAS-E.2 Materials and Methods: Two occupational therapists, independently reviewed 60 patients consecutively admitted to a traumatology service of a public hospital with a hip fracture, and rated the three CAS activities from 0 to 2, within the first post-surgery week. We determined the internal consistency of CAS-E using Cronbach's α coefficient. To test reliability, we used weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). We determined the systematic between-rater bias using the McNemar-Bowker test.Results: No between-rater bias was seen, and the Cronbach's α for the CAS-E was 0.89. The weighted kappa was ≥ 0.83 for the three individual activities and the total CAS-E, while the observed agreement was ≥ 0.87. The SEM and the SRD for the total CAS-E (0-6 points) were 0.18 and 0.83 points, respectively. Conclusions:We present the CAS for use in Spanish speaking countries and provide evidence for excellent relative and absolute reliability of the CAS-E to assess basic mobility for patients with hip fracture in an acute care hospital.

The New Mobility Score (NMS) is an easy to administer self-report measure of functional ability, and is used worldwide as a hip fracture (HF) score, but a Spanish version does not exist. The aim of the study is to translate NMS into Spanish, and to measure its inter-rater reliability, internal consistency, and concurrent validity in a sample of Spanish speaking patients with HF. A reliability and validity study with a sample of 60 adults, 65 years or older (46 women and 14 men; mean age 81.7 years) with a hip fracture admitted consecutively to the acute trauma service of the Health Campus Hospital of Granada. The participants were interviewed during the first week after surgery by an occupational therapist or a physiotherapist. The statistical test used for analysis were: Cronbach’s α coefficient, McNemar–Bowker test, Bland–Altman plot, Spearman´s Rho, and Mann–Whitney U test. The Cronbach’s α coefficient was 0.90. No inter-rater systematic differences were found. We noted significant associations between the Spanish Version of the Modified New Mobility Score (NMS-ES) and selected health outcomes: Age, cognition, pre-fracture function, and basic mobility. The NMS-ES is a reliable and valid instrument to assess pre-injury functional levels for patients with HF in Spanish speaking countries.

Background and Purpose: A hip fracture is an unexpected traumatic event. Caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregivers who perceive a higher level of preoccupation about the care of their family member/friend. The objective of this study was to develop and test feasibility for a post–hip fracture inpatient instructional workshop for caregivers of older adults with hip fracture and to establish their knowledge of hip fracture recovery and perceptions of the utility and satisfaction with the workshop. Methods: This 2-part study was conducted at the University Hospital of Granada, Spain, from September 2016 to April 2017. We invited caregivers of patients (60 years of age or older) hospitalized for a surgically treated fall-related hip fracture to attend an informational and skill development hospital-based workshop (60-90 minutes in duration) on postdischarge management strategies. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture and their perceived concerns. Furthermore, we requested that they provide feedback on workshop utility and satisfaction (0-10 points) and suggestions for improving the workshop. Results and Discussion: We delivered 42 workshops over an 8 month period. One hundred three caregivers attended the sessions and enrolled in the study, mean (SD) age: 52.1 (12.8) years. Sixty-nine percent of the caregivers were women. Caregivers' main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1, Q3) of both workshop utility and satisfaction was 10 (10, 10), minimum-maximum: 7 to 10. Conclusions: Caregivers in this study stated that the workshop was useful and satisfactory. Because caregivers play such a vital role in recovery after hip fracture, providing knowledge and skill development as part of health care delivery may support more person-centered care.

BackgroundOsteoporotic hip fracture causes a high level of dependency in older adults, as their functional status suddenly decreases greatly. In addition, the high level of pain and the fear of falling that they frequently experience maintain this decrease in functional status for a longer period. Digital health, the promotion of health through the use of Information and Communication Technologies, emerges as an option for the rehabilitation of older adults with hip fracture.ObjectivesTo test the effectiveness of the co-created ActiveHip+ mHealth system on the recovery of the functional status and the decrease of the pain and fear of falling in older adults with hip fracture.MethodsA total of 110 older adults with hip fracture and their family caregivers were recruited from hospitals in southern Spain. Participants were randomly assigned to an intervention group (n = 55), in which rehabilitation was performed through ActiveHip+, or to a control group (n = 55), in which they received standard rehabilitation for a hip fracture from the Andalusian Public Health System. Participants were assessed during the hospital stay and 3 months after surgery. Feasibility assessment was done through adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment was conducted through patient-reported outcomes, such as the Functional Independence Measure and the New Mobility Score Spanish version for functional status, the Numerical Rating Scale for pain and the Short Falls Efficacy Scale-International for fear of falling.ResultsWe obtained positive results in terms of feasibility as we observed 88% adoption, 82% usage, 8.35/10 in satisfaction with the app and 4.3/5 in perceived quality of the app.The functional status of patients allocated to the intervention group (those using ActiveHip+) had a statistically significant greater recovery than participants of the control group at 3-months (medium effect size: 0.70 Cohen’s d; p = 0.02) and (medium effect size: 0.62 Cohen’s d; p = 0.03) respectively. In addition, the level of pain was statistically significant lower in participants of the intervention group than those in the control group (medium effect size: 0.45; Cohen’s d p = 0.03). Regarding the fear of falling, there was no statistically significant difference (medium effect size: 0.32 Cohen’s d; p = 0.17).ConclusionThe ActiveHip+ mHealth system is effective in the recovery of the functional status and the decrease of pain in older adults with hip fracture. However, it was not effective on the decrease of the fear of falling.Table 1.Baseline characteristics and pre-interventions raw of sample divided by groups.VariableIntervention group (n= 46)Control group (n= 53)PAge (years), Mean (SD)79.70 (7.2)79.94 (7.8)0.73Sex,n(%)0.83 Women33 (72)37 (70) Men13 (28)16 (30)Type of injury,n(%)0.58 Fracture Cervical Femoral (Intracapsular)21 (46)22 (42) Fracture Trochanteric (Extracapsular)20 (43)23 (43) No fracture, but degeneration5 (11)8 (15)Type of surgery,n(%)0.94 Prosthesis14 (65)13 (25) Screw Plate30 (31)35 (66) PFN-A Nail1 (2)5 (9) Others1 (2)0 (0)Hospital stay (days), Mean (SD)6.83 (4.2)5.64 (3.3)0.08Functional status at hospital discharge FIM (Total score 18-126) Mean (SD) NMS-ES (Total score 0-9) Mean (SD)78.13 (19.23)5.89 (2.31)75,26 (13,39)6.58 (1.73)0.360.26Fear of falling at hospital discharge SFES-I (Total score 7-28) Mean (SD)19.37 (7.2)20.08 (5.18)0.58Pain level at hospital discharge NRS (Total score 0-10) Mean (SD)5.89 (2.31)6.58 (1.73)0.91n =sample size; SD = standard deviation; PFN-A = Proximal Femoral Nail; FIM = Functional Independence Measure; NMS-ES = New Mobility Score Spanish version; SFES-I = Short Falls Efficacy Scale; NRS = Numeric rating scaleFigure 1.Effect sizes of the ActiveHip+ mHealth system on the functional status, pain and fear of falling (per-protocol analysis).REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.