Background
Methods
Study design
Setting and participants
Comprehensive geriatric care (CGC)
Control: usual care treatment
Intervention
Psychological component
Physical component
Staffing levels and assessors
Outcome measures
Demographic characteristics
Variable | Intervention group n = 63 | Control group n = 63 |
P-value | |
---|---|---|---|---|
Age, (years) mean (SD) | 82.0 (8.0) | 80.5 (7.7) | 0.27 | |
Gender, n (%) | Women | 47 (75) | 49 (78) | 0.68 |
Men | 16 (25) | 14 (22) | ||
Type of fracture, n (%) | Cervical | 35 (56) | 24 (38) | 0.07 |
Trochanteric | 28 (44) | 39 (62) | ||
Type of surgery, n (%) | LIH/Pinnloc | 6 (9) | 10 (16) |
0.04
|
Hemiarthroplasty | 17 (27) | 7 (11) | ||
Total hip replacement | 10 (16) | 8 (13) | ||
Plate and screw | 8 (13) | 11 (17) | ||
Intermedullary nail | 22 (35) | 27 (43) | ||
ASA score (1–5), n (%) | 1–2 | 42 (67) | 37 (59) | 0.46 |
3–4 | 21(33) | 26 (41) | ||
General health, n (%) | Good to excellent | 35 (56) | 37 (59) | 0.9 |
SPMSQ, n (%) | 9–10 | 53 (84) | 57 (90) | 0.35 |
Living alone, n (%) | 41 (65) | 39 (62) | 0.8 | |
Housing, n (%) | House | 43 (68) | 43 (68) | 1.0 |
Flat | 20 (32) | 20 (32) | ||
Assistance from home help services/relative/other, n (%) | 35 (56) | 36 (57) | 1.0 | |
Walking aid prior to fracture indoors n, (%) | None | 44 (70) | 48 (76) | 0.33 |
Stick/crutches | 6 (9) | 3 (5) | ||
Rollator/walker | 13 (21) | 12 (19) | ||
Walking aid prior to fracture outdoors, n (%) | None | 29 (46) | 32 (51) | 0.81 |
Sticks/crutches/nordic | 10 (16) | 11 (17) | ||
Rollator | 23 (37) | 19 (30) | ||
Wheelchair | 1 (1) | 1 (1) | ||
Walked outdoors previous month, n (%) | Yes, alone | 39 (62) | 47 (74) | 0.27 |
Yes, with company | 10 (16) | 8 (13) | ||
No | 14 (22) | 8 (13) | ||
I-ADL, independent n (%) | Cooking | 48 (77) | 55 (89) |
0.038
|
Cleaning | 37 (60) | 41 (66) | 0.6 | |
Shopping | 41 (66) | 39 (63) | 0.9 | |
Transport | 50 (81) | 47 (76) | 0.6 | |
Fall before fracture, n (%) | Yes | 25 (40) | 25 (40) | 1.0 |
Length of stay, (days) mean (SD) | 14.9 (5.9) | 13.4 (4.7) | 0.13 | |
Discharge destination, n (%) | Home | 42 (67) | 51 (81) | 0.08 |
Intermediate rehab | 21 (33) | 11 (18) | ||
Other hospital | 1 (1) |
Primary outcome
Self-rated degree of participation
Secondary outcomes
Activities of daily living (ADL)
Functional balance
Balance confidence
Physical performance
Domain | Assessment | Pre-fracture | Post-operatively | At discharge | One month follow-up |
---|---|---|---|---|---|
Personal ADL | TLS-BasicADL | X | X | X | X |
Instrumental ADL | ADL-staircase | X | X | ||
Balance confidence | FES(S) | X | X | ||
Functional balance | BBS | X | X | ||
Functional physical mobility | SPPB, TUG | X | X | ||
Self-rated participation | 4-part questionnaire | X |
Statistical methods
Results
Primary outcome
Self-rated degree of participation
Comparison between groups at discharge
Participation questions | Degree of participation | Intervention group n = 58 | Control group n = 57 |
p-value | ||
---|---|---|---|---|---|---|
n | n (%) | n | n (%) | |||
To what degree do you feel you have participated in your rehabilitation on the ward? | Very high | 29 | 55 (95) | 21 | 44 (77) |
p = 0.021 |
Moderate | 26 | 23 | ||||
Small | 3 | 3 (5) | 13 | 13 (23) | ||
Not at all | 0 | 0 | ||||
To what degree have you worked together with the OT and PT towards common goals regarding your rehabilitation? | Very high | 30 | 48 (83) | 17 | 36 (63) |
p = 0.003 |
Moderate | 18 | 19 | ||||
Small | 10 | 10 (17) | 11 | 21 (37) | ||
Not at all | 0 | 10 | ||||
To what degree do you feel you have taken personal responsibility for your rehabilitation? | Very high | 37 | 52 (90) | 20 | 42 (74) |
p = 0.008 |
Moderate | 15 | 22 | ||||
Small | 6 | 6 (10) | 11 | 15 (26) | ||
Not at all | 0 | 4 | ||||
Have you been involved in making decisions about your care and treatment as much as you wished? | Very high | 39 | 55 (95) | 20 | 45 (79) |
p = 0.003 |
Moderate | 16 | 25 | ||||
Small | 2 | 3 (5) | 11 | 12 (21) | ||
Not at all | 1 | 1 |
Secondary outcomes
Activities of daily living
P-ADL (TLS-BasicADL)
Discharge | 1 month | |||||
---|---|---|---|---|---|---|
TLS-BasicADL Activity | Intervention group | Control group |
p-value | Intervention group | Control group |
p-value |
Lower body hygiene |
n = 60 |
n = 58 |
0.025
|
n = 52 |
n = 54 | 0.734 |
Independent | 41 | 36 | 49 | 50 | ||
Supervision | 12 | 5 | 0 | 0 | ||
Active help | 7 | 17 | 3 | 4 | ||
Lower body dressing |
n = 60 |
n = 58 |
0.000
|
n = 52 |
n = 54 | 0.921 |
Independent | 39 | 22 | 41 | 43 | ||
Supervision | 7 | 1 | 0 | 0 | ||
Active help | 14 | 35 | 11 | 11 | ||
Stairs |
n = 33 |
n = 27 | 0.093 |
n = 46 |
n = 48 |
0.009
|
Independent | 4 | 8 | 21 | 21 | ||
Supervision | 21 | 10 | 18 | 8 | ||
Active help | 8 | 9 | 7 | 19 | ||
Walking outdoors | n/a as not tested in majority |
n = 47 |
n = 49 |
0.022
| ||
Independent | 22 | 22 | ||||
Supervision | 16 | 7 | ||||
Active help | 9 | 20 |
I-ADL (ADL-staircase)
Functional balance (BBS), balance confidence (FES-S), and physical performance (SPPB and TUG)
Comparison of scores at discharge median (range) |
p-value | Comparison of scores at 1 month median (range) |
p-value | Comparisons of differences in scores between discharge to 1 month mean (SD) |
p-value | Comparisons of change over time discharge to 1 month p-value | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
IG | CG | IG | CG | IG | CG | IG | CG | ||||
Functional balance | |||||||||||
BBS(0–56) | 25 (4–52) | 28(5–55) | 0.868* | 38(13–56) | 35 (16–56) | 0.464* | 9.7 (7.3) | 7.6 (6.2) | 0.122 | < 0.000** | < 0.000** |
Balance confidence | |||||||||||
FES-S (0–130) | 73(7–125) | 73(18–130) | 0.825* | 89(31–130) | 90(16–130) | 0.981* | 19.2(22.2) | 17.7(19.2) | 0.724 | < 0.000** | < 0.000** |
Physical performance | |||||||||||
SPPB(0–12) | 3.5(0–9) | 4 (1–9) | 0.533* | 5 (1–11) | 5 (1–12) | 0.268* | 2.0(1.7) | 1.4 ± 1.9 | 0.083 | < 0.000** | < 0.000** |
TUG (sec) | 32 (12–114) | 28.5 (10–120) | 0.852* | 20(10–173) | 22 (8–95) | 0.808* | −11.2(22.2) | −12.5(19.5) | 0.755 | < 0.000** | < 0.000** |
Number of falls reported at 1 month
Risk for falls (BBS, SPPB, TUG)
Discharge | 1 month | |||
---|---|---|---|---|
Outcome and cut-off score | Intervention Group n (%) | Control Group n (%) | Intervention Group n (%) | Control Group n (%) |
BBS ≤ 47 | 54 (95) | 54 (95) | 42 (81) | 44 (85) |
SPPB ≤ 6 | 53 (91) | 51 (90) | 36 (69) | 35 (66) |
TUG > 24 s | 36 (64) | 37 (68) | 19 (36) | 22 (42) |