Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial

Abstract

To evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program. Design: Planned analysis of a randomized controlled trial with 3-and 12-month follow-ups. Setting: Geriatric ward, ordinary housing, and residential care facilities. Participants: Of 466 people screened for eligibility, participants (NZ205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups. Intervention: Individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors. Main Outcome Measures: Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants' homes. Results: There were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (PZ.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (PZ.207). Conclusions: In older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.

Functional Status in Relation to Depression Among Elderly Individuals in Indonesia

“…Functional status was assessed by using the Barthel index, which is a measurement tool developed by Mahoney and Barthel [15] in 1965. This tool is widely used to assess the functional status of patients after stroke, colorectal cancer, fractures and several other medical and even social conditions in nursing homes and the general population [16][17][18][19][20][21][22][23]. A total of 10 questions were used to assess the respondents' ability to perform their daily activities, including determining how much care and assistance was needed, and this assessment was carried out over a month.…”

<p>Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia – A Subgroup Analysis of a Randomized Controlled Trial</p>

“…This post hoc subgroup analysis was part of a parallelgroup RCT conducted between May 2008 and June 2011 at the Geriatric Department of the University Hospital of Umeå in Sweden. The method of the RCT has been described in detail previously, [16][17][18] and the study is registered at Current Controlled Trials Ltd. (ISRCTN 15738119). People after hip fracture surgery (cervical or trochanteric fracture), aged 70 or older, and living in the municipality of Umeå in ordinary housing or in residential care facilities were eligible.…”

“…Participants allocated to the GIHR intervention, as described in detail earlier, [16][17][18] were also initially treated according to the in-hospital multifactorial rehabilitation program, but with the aim of early discharge and continuation of rehabilitation in their homes with the support of the GIHR team for a maximum of 10 weeks. Discharge was possible when the participants had no medical obstacles, could manage basic transfers, and had the care they required at home.…”

“…We have, however, in a randomized controlled trial (RCT) evaluated a Geriatric Interdisciplinary Home Rehabilitation (GIHR) intervention for older people with hip fracture, including those with dementia and those living in residential care facilities, compared with in-hospital geriatric care according to a multifactorial rehabilitation program. The results showed that functional recovery in ADL and walking ability, as well as complications and readmissions after discharge, were comparable between the GIHR and control groups, [16][17][18] although the GIHR group had a significantly shorter initial postoperative length of stay (LOS) in hospital. Half of the participants in the RCT had dementia at baseline.…”

Effectiveness of community-based rehabilitation interventions incorporating outdoor mobility on ambulatory ability and falls-related self-efficacy after hip fracture: a systematic review and meta-analysis

“…We excluded two potentially eligible RCTs that we did not receive responses from the authors to determine whether outdoor mobility was included in their rehabilitation intervention [43,44]. We excluded RCTs not published in English and secondary analyses of RCTs (including 3 secondary analyses of RCTs included in this review [45,47]). These exclusions may have led to publication bias through the exclusion of evidence relevant to our review question.…”