Feasibility of allied health assistant management of people with acute hip fracture: protocol for a feasibility randomised controlled trial

Abstract

IntroductionGuidelines for hip fracture care state that patients with hip fracture should be mobilised on the day after surgery and at least once a day thereafter. However, compliance with these guidelines is poor. One approach that would assist physiotherapists to meet mobility guidelines after hip fracture is to delegate the provision of daily mobilisation to allied health assistants under their supervision. Therefore, we plan to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient rehabilitation to patients with hip fracture.Methods and analysisUsing a parallel group randomised controlled design with one-to-one allocation, participants will be randomly allocated to an experimental group (allied health assistant management) or a comparison group (physiotherapist management). Inclusion criteria are: adult with diagnosis of hip fracture; inpatient in acute hospital; walked independently pre-hip fracture and able to communicate in conversational English. The experimental group will receive routine physiotherapy rehabilitation, including daily mobilisation, from an allied health assistant following initial physiotherapist assessment. The comparison group will receive routine rehabilitation from a physiotherapist. The primary outcome will be the feasibility of allied health assistant management of patients with hip fracture. Feasibility will be determined using the following areas of focus in Bowen’s feasibility framework: acceptability (patient satisfaction), demand (proportion of patients who participate), implementation (time allied health assistant/physiotherapist spends with participant, occasions of service) and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant care will be interviewed to explore their perspectives on feasibility. Secondary outcomes include compliance with daily mobilisation guidelines, discharge destination, hospital readmission, falls, functional activity and length of stay. We aim to recruit 50 participants. Descriptive statistics will be used to describe feasibility and mobilisation rates will be calculated using Cox proportional hazards regression to compare compliance with mobilisation guidelines.Ethics and disseminationEthics approval was obtained from the Peninsula Health human research ethics committee (HREC/63 005/PH-2020). The findings will be disseminated in peer-reviewed journals and conference presentations.Trail registration numberAustralian and New Zealand Clinical Trial Registry; ACTRN12620000877987; Pre-results.

Staying Active with Multimorbidity In Acute hospital settings (StAMInA) trial: protocol for a feasibility randomised controlled trial of allied health assistant mobility rehabilitation for patients with multimorbidity

“…We aim to recruit 60 patient participants, a sample size comparable to other feasibility trials, which should enable the primary aim of feasibility to be addressed 25 49 50. We also plan to interview 6–10 staff participants, as recommended for thematic analysis of small qualitative projects 51…”

“…If the patient is not appropriate for mobilisation they will not be eligible for participation in the study. Mobilisation will be contraindicated if the patient experiences any of the following complications: severe pain; nausea or vomiting with or without antiemetic; vitally unstable (eg, hypotension, febrile, abnormal heart rate or rhythm); disorientated, heavily sedated or difficult to rouse 25…”

“…Patient satisfaction with physiotherapy care will be measured using a modified 11-item version of a questionnaire for hospital inpatients receiving physiotherapy care 25 39. The patient rates their agreement with each item on a 5-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree) (table 4).…”

“…While allied health assistant care of people with acute hip fracture has been recently trialled, 25 people with multimorbidity can present to hospital with a wider variety of acute medical conditions, such as cardiac, renal, gastrointestinal and respiratory disease. Compared with surgical care, the management of these conditions may not be informed by a clinical guideline or pathway and therefore, there is greater variation in how they are clinically managed.…”

Allied health assistants' perspectives of their role in healthcare settings: A qualitative study

“…Some allied health professions and their lead representing organisations are understandably protective of their professional role and may be reluctant to engage AHAs in these discussions due to fear of losing control over decisions regarding AHAs' scope of practice (Huglin et al, 2021 ; Mickan et al, 2018 ). However, expanding AHAs' scope of practice is not intended to substitute the role of AHPs, but rather enable AHPs to practice at the higher end of their scope and, in turn, reduce healthcare workforce expenditure (Snowdon et al, 2021 ; Somerville et al, 2015 ). This will enhance the capacity of allied health to meet the needs of an ageing population with greater healthcare needs (World Health Organisation, 2015 ).…”