BackgroundIt is not clear whether occupational therapy is of value for hip fracture patients.Patients and methods In a randomized trial we studied the effects of an early, individualized, postoperative occupational training (OT) program on the ability of hip fracture patients to perform ADL and IADL. Secondary endpoints were self-reported fear of pain and pain when performing ADL and IADL. The need for technical aids and/or home adaptations was also investigated. 100 eligible patients (aged ≥ 65 years, with independent residence) were randomized 50:50 to an OT or control group (conventional care). During their hospital stay, members of the OT group received individual daily training which included the use of technical aids. Before discharge, the occupational therapist paid a home visit together with the patient. All patients were assessed 2-4 days after surgery, at discharge and after 2 months, using the Klein-Bell ADL scale and a modified version of the Disability Rating Index.Results At discharge, the OT group had better ability to dress, to take care of personal hygiene and bathing activities independently, and to make toilet visits. Age, sex, type of fracture or length of stay at the hospital made no significant contribution to explaining the better ADL ability on discharge. After 2 months, all patients had regained their ADL and IADL abilities. Half of the patients required technical aids and adaptations in their homes.Interpretation Individualized OT-training speed up the ability of patients to perform ADL, thus enhancing the likelihood of patients returning to independent living and reducing the need for postoperative care at home.
Hip fracture is a major healthcare problem in terms of cost and suffering (Zethraeus et al. 1997, Haentjens et al. 2001, Tidermark et al. 2002. Most patients are octogenarians and have many other social and medical problems.Intensive, physiotherapy training during the postoperative period improves the functional capacity of the patient (Barnes and Dunovan 1987, Guccione et al. 1996), as this training focuses mainly on the function of various muscle groups that are important for the mobility of the patient. Occupational therapy (OT) training focuses on the activities that are necessary for independent living, i.e., the patientʼs ability to perform the activities of daily living (ADL) and the instrumental activities of daily living (IADL). It has been suggested that hip fracture patients should receive OT training soon after surgery (Kumar and Redford 1984, Thorngren 1991, Byers and Parker 1992, Stewart and McMillan 1998, but there have been no controlled trials of whether this training improves the ADL and IADL abilities of patients faster. We carried out a randomized, controlled trial to study the effects of an early, individualized, post-operative OT training program.
Participants and methods
PatientsThe hip fracture patients included in the study were treated at the Orthopedic Department of Huddinge University Hospital and were aged ≥ 65 years of age, proficient in Swedish,...
