A Group Learning Programme for Old People with Hip Fracture: A Randomized Study

Elinge, Eva; Löfgren, Britta; Gagerman, E; Nyberg, Lars

doi:10.1080/11038120310004475

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…The rest of the included studies 13,72,79,82,[84][85][86]88,89,94,98,99,104,112,113,116,[125][126][127][128][129]134,141,142,145,150,159,[163][164][165][166]168,[170][171][172][173][174][175][176][177][178][179][180][181][182][183][185][186][187][188][189][190][191]193,194,[196][197]…”

Section: Summary Of Outcomesunclassified

“…69,83,94,95,98,100,102,105,111,116,117,119,120,123,124,127,128,132,[138][139][140]144,150,155,157,159,163,167,184 Seventeen studies compared the development of multidisciplinary co-ordination programmes with usual care or another existing programme. 69,83,98,102,111,117,119,120,123,124,127,132,144,155,157,159,184 There was large variation in these programmes from different health-care systems, but common features included comprehensive geriatric assessment both pre and post surgery, assessment of patient needs and assignment of appropriate health-care staff to address those needs, regular multidisciplinary meetings to discuss progress and care pathways that continue into the community after discharge. Usual or conventional care varied greatly among the studies, ranging from simple control of post-operative symptoms 117 to comprehensive assessment.…”

Section: Process or System Improvementmentioning

confidence: 99%

“…185 Eight studies included patients aged ≥ 50 years; 87,98,103,118,173,187,188,192 18 studies included patients aged ≥ 60 years; 12,89,96,104,114,117,119,122,132,133,149,154,164,[193][194][195][196][197] 19 studies included patients aged ≥ 70 years; 69,72,79,88,106,108,110,111,116,120,131,136,143,148,150,161,180,183,184 and seven studies included patients aged ≥ 80 years. 13,81,123,134,137,152,178 The age of the included participants could not be determined from the study reports for four studies.…”

Section: A Community-based Multidisciplinary Rehabilitation Package Fmentioning

confidence: 99%

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Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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Section: Summary Of Outcomesunclassified

Section: Process or System Improvementmentioning

confidence: 99%

Section: A Community-based Multidisciplinary Rehabilitation Package Fmentioning

confidence: 99%

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Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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“…A randomised study of patients with hip fractures examined whether a group learning programme would influence the participants' perceived activity performance and ability to participate in social life [12]. The results of the study show a significantly better ability of patients with osteoporosis to participate in social life after the intervention [12]. As hip fractures are often related to osteoporosis, the study may indicate that group treatment for patients diagnosed with osteoporosis is a useful complement to medication and other kinds of treatment.…”

Section: Introductionmentioning

confidence: 76%

“…When there is engagement, occupations are meaningful and actions are purposeful [11]. A randomised study of patients with hip fractures examined whether a group learning programme would influence the participants' perceived activity performance and ability to participate in social life [12]. The results of the study show a significantly better ability of patients with osteoporosis to participate in social life after the intervention [12].…”

Section: Introductionmentioning

confidence: 95%

Professional views on patient education in osteoporosis

Bångsbo

Björklund

2010

Arch Osteoporos

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Summary The aim of this study was to investigate patient education in osteoporosis, with a consensus-building Delphi survey. The results showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain. Introduction According to the World Health Organization, osteoporosis is a major health problem. The morbidity is caused by fractures associated with pain and decreased physical function, social function and well-being. The aim of this study was to investigate and reach consensus about how so-called osteoporosis schools are run by professionals in Sweden with a focus on intervention and evaluation. Method The study design was a consensus-building, threeround Delphi survey. Questionnaires were sent by web and post to an expert panel comprising 15 nurses, occupational therapists and physiotherapists. In round 1, they were asked to write descriptions within the frame of eight domains related to intervention and evaluation. In the second and third rounds, the Delphi panel was asked to mark on a Likert scale the importance of 40 statements within these domains. Results The answers showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain. The schools comprise theoretical elements as well as practical exercises. Patients with fractures related to osteoporosis are offered participation. There is a lack of a theoretical basis, as well as of evidence, for present treatment models. Evaluation ought to be done systematically, and for this purpose, different questionnaires are used. Experts assert that evaluations show that patients gain increased activity levels, function, knowledge about osteoporosis, empowerment and pain reduction. Conclusions Consensus was reached in 29 of 40 items.

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Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people

Crotty

Unroe

Cameron

et al. 2010

Cochrane Database of Systematic Reviews

108

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Some outcomes may be amenable to psychosocial treatments; however, there is insufficient evidence to recommend practice changes. Further research on interventions described in this review is required, including attention to timing, duration, setting and administering discipline(s), as well as treatment across care settings. To facilitate future evaluations, a core outcome set, including patient-reported outcomes such as quality of life and compliance, should be established for hip fracture trials.

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A Group Learning Programme for Old People with Hip Fracture: A Randomized Study

Cited by 9 publications

References 17 publications

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Professional views on patient education in osteoporosis

Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people

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