Abstract
Background: A hip fracture is a serious event for older adults, given that approximately 50% do not regain their habitual level of physical function, and the mortality rate is high, as is the number of readmissions. The gap in healthcare delivery, as separated into two financial and self-governing sectors, might be a contributing cause of inferior rehabilitation and care for these patients. Therefore, we aim to assess the effect of continuous and progressive rehabilitation and care across sectors for older adults after hip fracture.
Methods/design: The project is designed as a stepped-wedge cluster-randomised controlled trial. The study population of patients are older adults 65 years of age and above discharged after a hip fracture and healthcare professionals in primary and secondary care (municipalities and hospitals). In addition, health care professionals from different sectors (hospital and municipalities) will be engaged in the empowerment-orientated praxis, through a workshop for health care professionals with knowledge sharing to the older adults using a digital health application (app). The rehabilitation intervention consists of 12 weeks progressive resistance exercises initiated 1-2 days after discharge. To improve communication across sectors, a videoconference involving the patient and physiotherapists from both sectors, will be conducted.
At Day 3 after discharge, an outreach nurse performs a thorough assessment including measurement of vital signs. A hotline to the hospital for medical advice is a part of the intervention. The intervention is delivered as an add-on to the usual rehabilitation and care, and it involves one regional hospital and the municipalities within the catchment area of the hospital.
The primary outcome is a Timed Up and Go test eight weeks post-surgery
Discussion: Using a stepped-wedge design, the intervention will be assessed as well as implemented in hospital and municipalities, hopefully for the benefit of older adults after hip fracture. Furthermore, the collaboration between the sectors is expected to improve.
Methods/design: The project is designed as a stepped-wedge cluster-randomised controlled trial. The study population of patients are older adults 65 years of age and above discharged after a hip fracture and healthcare professionals in primary and secondary care (municipalities and hospitals). In addition, health care professionals from different sectors (hospital and municipalities) will be engaged in the empowerment-orientated praxis, through a workshop for health care professionals with knowledge sharing to the older adults using a digital health application (app). The rehabilitation intervention consists of 12 weeks progressive resistance exercises initiated 1-2 days after discharge. To improve communication across sectors, a videoconference involving the patient and physiotherapists from both sectors, will be conducted.
At Day 3 after discharge, an outreach nurse performs a thorough assessment including measurement of vital signs. A hotline to the hospital for medical advice is a part of the intervention. The intervention is delivered as an add-on to the usual rehabilitation and care, and it involves one regional hospital and the municipalities within the catchment area of the hospital.
The primary outcome is a Timed Up and Go test eight weeks post-surgery
Discussion: Using a stepped-wedge design, the intervention will be assessed as well as implemented in hospital and municipalities, hopefully for the benefit of older adults after hip fracture. Furthermore, the collaboration between the sectors is expected to improve.
| Original language | English |
|---|---|
| Article number | 375 |
| Journal | Trials |
| Volume | 23 |
| ISSN | 1745-6215 |
| DOIs | |
| Publication status | Published - 7. May 2022 |
Bibliographical note
Preprint published 20 Sep, 2021The study is approved by the Regional Scientific Ethics Committees of Southern Denmark (S-20200070) and the Danish Data Protection Agency (20-21854). Clinical Trial Identifier (NCT04424186) https://clinicaltrials.gov/ct2/show/NCT04424186.
Keywords
- Between sectors
- Care
- Empowerment
- Hip fracture
- Physical function
- Rehabilitation
- Stepped-wedge cluster randomised controlled trial
- Humans
- Patient Discharge
- Hip Fractures/diagnosis
- Randomized Controlled Trials as Topic
- Time and Motion Studies
- Aged
- Exercise Therapy/methods
- Postural Balance