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.

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.

Introduction Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. Methods The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients’ quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. Results The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p  =  0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: −0.50 SDs; p  =  0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p  =  0.022). Discussion The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.

Objective Half of older adults undergoing hip surgery do not recover their previous functional status. mHealth is a promising tool for rehabilitating older adults after hip surgery. This study aimed to test the feasibility of the ActiveHip+ mHealth system in older adults after hip surgery. Methods Sixty-nine older adults who had undergone hip surgery and their family caregivers were recruited from hospitals in Spain and Belgium and used the ActiveHip+ mHealth system for 12 weeks. Assessments were made during hospital stay and 3 months after surgery. Feasibility assessment included: 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 included: patient-reported outcomes, such as functional status (Functional Independence Measure) and performance-based outcomes, such as physical fitness (Short Physical Performance Battery). Results The ActiveHip+ mHealth system obtained satisfactory feasibility results in both countries. In Spain, we observed 85% adoption, 64% usage, 8.86/10 in satisfaction with the app and 4.42/5 in perceived quality of the app. In Belgium, we observed 82% adoption, 84% usage, 5.16/10 in satisfaction with the app and 3.52/5 in app's perceived quality. The intervention had positive effects on levels of functional status, pain and physical fitness. Conclusions The ActiveHip+ mHealth system is a feasible tool to conduct the rehabilitation in older adults after hip surgery. Although the intervention seemed beneficial clinically, we do not recommend its implementation in clinical settings until appropriately designed randomised clinical trials confirm these results.