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

Crotty, Maria; Unroe, Kathleen T.; Cameron, Ian D.; Miller, Michelle; Ramı́rez, Gilbert; Couzner, Leah

doi:10.1002/14651858.cd007624.pub3

Cited by 108 publications

(59 citation statements)

References 68 publications

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“…Focusing on optimal rehabilitation in order to improve patients' physical independence may increase the rate of patients remaining home-dwellings after a hip-fracture [26]. Results from the Trondheim Hip Fracture Trial showed that immediate admission before initial surgery to a ward delivering comprehensive geriatric care (CGC) improved mobility at four months as compared with the usual orthopaedic care (OC).…”

Section: Discussionmentioning

confidence: 99%

One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial

Hektoen

Saltvedt

Sletvold

et al. 2016

Scand J Public Health

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Aims: The aim of this study was to estimate the one-year health and care costs connected to a hip fracture for home dwelling patients 70 years and older in Norway, paying specific attention to patient status at the time of the fracture and cost differences due to various patient pathways after the fracture.Methods: Data on health and care service provision were extracted from hospital and municipal records and from national registries, while data on unit costs were collected from the municipality, the hospital administrations, and published studies. Four different patient pathways were identified and total costs for sub-groups of patients according to age, gender, fracture type, and instrumental activity of daily living at fracture incidence were calculated. Descriptive statistics were used to identify cost estimates.Results: The mean total one-year costs per patient were 68,376 EUR, and the costs for patients alive one year after the hip fracture constituted 71,719 EUR. The patients' age and pre-fracture functional status contributed most to the total costs.Conclusion: On average, care costs amounted for more than 50% of the total costs, and even for patients with good functional status before the hip fracture, care costs amounted to 40% as compared to hospital costs of 38%. To reduce the financial costs of hip-fractures for the care sector, the results point to the importance of preventive programs to reduce the risk of a hip fracture, but also to the importance of comprehensive geriatric care in the initial phase after a hip fracture.

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Section: Discussionmentioning

confidence: 99%

One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial

Hektoen

Saltvedt

Sletvold

et al. 2016

Scand J Public Health

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“…To our knowledge, this is the first metaanalysis of extended rehabilitation for people with hip fractures, and the results support its effectiveness. Other reviews either have been very broad, preempting a concrete conclusion, or have had different scopes, [43][44][45][46] but none covered only extended rehabilitation. For instance, in their 2011 Cochrane review, Handoll et al 11 studied mobilization strategies across all care settings (inpatient acute care, inpatient rehabilitation, community-based rehabilitation), making the scope of the review very broad, which contributed heterogeneity to the effects and consequently made it difficult to compare the studies included in their review or to pool the estimates for outcomes.…”

Section: Discussionmentioning

confidence: 99%

Extended Exercise Rehabilitation After Hip Fracture Improves Patients' Physical Function: A Systematic Review and Meta-Analysis

Auais

Eilayyan

Mayo³

2012

Physical Therapy

132

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BackgroundAlthough the principal goal of hip fracture management is a return to the pre-event functional level, most survivors fail to regain their former levels of autonomy. One of the most effective strategies to mitigate the fracture's consequences is therapeutic exercise.PurposeThe purpose of this study was to review and quantify the reported effects of an extended exercise rehabilitation program offered beyond the regular rehabilitation period on improving physical functioning for patients with hip fractures.SourcesThe Cochrane libraries, PubMed, CINAHL, PEDro, and EMBASE were searched to April 2012.Study SelectionAll randomized controlled trials comparing extended exercise programs with usual care for community-dwelling people after hip fracture were included in the review.Data Extraction and SynthesisTwo reviewers conducted each step independently. The data from the included studies were summarized, and pooled estimates were calculated for 11 functional outcomes.ResultsThirteen trials were included in the review and 11 in the meta-analysis. The extended exercise program showed modest effect sizes (ESs), which reached significance, under random theory, for knee extension strength for the affected and nonaffected sides (ES=0.47, 95% confidence interval [CI]=0.27–0.66, and ES=0.45, 95% CI=0.16–0.74, respectively), balance (ES=0.32, 95% CI=0.15–0.49), physical performance-based tests (ES=0.53, 95% CI=0.27–0.78), Timed “Up & Go” Test (ES=0.83, 95% CI=0.28–1.4), and fast gait speed (ES=0.42, 95% CI=0.11–0.73). Effects on normal gait speed, Six-Minute Walk Test, activities of daily living and instrumental activities of daily living, and physical function subscale of the 36-Item Short-Form Health Survey (SF-36-PF) did not reach significance. Community-based programs had larger ESs compared with home-based programs.ConclusionsTo the authors' knowledge, this is the first meta-analysis to provide evidence that an extended exercise rehabilitation program for patients with hip fractures has a significant impact on various functional abilities. The focus of future research should go beyond just effectiveness and study the cost-effectiveness of extended programs.

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“…ESD is shown to reduce the burden on acute providers and support patient recovery. 65 The funding of ESD through joint commissioning between the acute NHS providers, GPs, social services and central government highlights the role of joint working and resource pooling, but there remain variations across the UK, especially in rural areas, where a lack of funding can limit provision. 66,67 Intermediate services provide transitional, 'step-down' care between acute hospital and the domestic environment (usually for 30 days).…”

Section: Hospital Discharge and Patient Safety: Reviews Of The Literamentioning

confidence: 99%

“…69 The recent Cochrane reviews of long-term rehabilitation in care homes show no evidence of negative health outcomes. 65,70 A similar initiative is the introduction of reablement services. These usually involve a dedicated package of social care to support daily living in the immediate period following discharge (e.g.…”

Section: Hospital Discharge and Patient Safety: Reviews Of The Literamentioning

confidence: 99%

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

Waring

Marshall

Bishop

et al. 2014

Health Services and Delivery Research

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BackgroundHospital discharge is a vulnerable stage in the patient pathway. Research highlights communication failures and the problems of co-ordination as resulting in delayed, poorly timed and unsafe discharges. The complexity of hospital discharge exemplifies the threats to patient safety found ‘between’ care processes and organisations. In developing this perspective, safe discharge is seen as relying upon enhanced knowledge sharing and collaboration between stakeholders, which can mitigate system complexity and promote safety.AimTo identify interventions and practices that support knowledge sharing and collaboration in the processes of discharge planning and care transition.SettingThe study was undertaken between 2011 and 2013 in two English health-care systems, each comprising an acute health-care provider, community and primary care providers, local authority social services and social care agencies. The study sites were selected to reflect known variations in local population demographics as well as in the size and composition of the care systems. The study compared the experiences of stroke and hip fracture patients as exemplars of acute care with complex discharge pathways.DesignThe study involved in-depth ethnographic research in the two sites. This combined (a) over 180 hours of observations of discharge processes and knowledge-sharing activities in various care settings; (b) focused ‘patient tracking’ to trace and understand discharge activities across the entire patient journey; and (c) qualitative interviews with 169 individuals working in health, social and voluntary care sectors.FindingsThe study reinforces the view of hospital discharge as a complex system involving dynamic and multidirectional patterns of knowledge sharing between multiple groups. The study shows that discharge planning and care transitions develop through a series of linked ‘situations’ or opportunities for knowledge sharing. It also shows variations in these situations, in terms of the range of actors, forms of knowledge shared, and media and resources used, and the wider culture and organisation of discharge. The study also describes the threats to patient safety associated with hospital discharge, as perceived by participants and stakeholders. These related to falls, medicines, infection, clinical procedures, equipment, timing and scheduling of discharge, and communication. Each of these identified risks are analysed and explained with reference to the observed patterns of knowledge sharing to elaborate how variations in knowledge sharing can hinder or promote safe discharge.ConclusionsThe study supports the view of hospital discharge as a complex system involving tightly coupled and interdependent patterns of interaction between multiple health and social care agencies. Knowledge sharing can help to mitigate system complexity through supporting collaboration and co-ordination. The study suggests four areas of change that might enhance knowledge sharing, reduce system complexity and promote safety. First, knowledge brokers in the form of discharge co-ordinators can facilitate knowledge sharing and co-ordination; second, colocation and functional proximity of stakeholders can support knowledge sharing and mutual appreciation and alignment of divergent practices; third, local cultures should prioritise and value collaboration; and finally, organisational resources, procedures and leadership should be aligned to fostering knowledge sharing and collaborative working. These learning points provide insight for future interventions to enhance discharge planning and care transition. Future research might consider the implementation of interviews to mediate system complexity through fostering enhanced knowledge sharing across occupational and organisational boundaries. Research might also consider in more detail the underlying complexity of both health and social care systems and how opportunities for knowledge sharing might be engendered to promote patient safety in other areas.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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

Cited by 108 publications

References 68 publications

One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial

One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial

Extended Exercise Rehabilitation After Hip Fracture Improves Patients' Physical Function: A Systematic Review and Meta-Analysis

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

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