Umeå University's logo

umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-8702-3437
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-4449-049x
Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.ORCID iD: 0000-0002-3754-5026
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Show others and affiliations
2020 (English)In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 101, no 4, p. 571-578Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program.

Design: Planned analysis of a randomized controlled trial with 3- and 12-month follow-ups.

Setting: Geriatric ward, ordinary housing, and residential care facilities.

Participants: Of 466 people screened for eligibility, participants (N=205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups.

Intervention: Individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors.

Main Outcome Measures: Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants’ homes.

Results: There were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (P=.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (P=.207).

Conclusions: In older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 101, no 4, p. 571-578
Keywords [en]
Activities of daily living, Geriatrics, Hip fractures, Patient care team, Rehabilitation
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-173439DOI: 10.1016/j.apmr.2019.12.007ISI: 000543000800001PubMedID: 31935353Scopus ID: 2-s2.0-85079068977OAI: oai:DiVA.org:umu-173439DiVA, id: diva2:1453534
Conference
World Confederation for Physical Therapy Congress, Geneva, Switzerland, May 10–13, 2019
Funder
Region VästerbottenThe Dementia Association - The National Association for the Rights of the DementedThe Kempe FoundationsAvailable from: 2020-07-10 Created: 2020-07-10 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Team-based home rehabilitation after hip fracture in older adults: effects, experiences and impact of dementia
Open this publication in new window or tab >>Team-based home rehabilitation after hip fracture in older adults: effects, experiences and impact of dementia
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Teambaserad hemrehabilitering efter höftfraktur bland äldre människor : effekter, upplevelser och påverkan av demens på utfallen
Abstract [en]

BACKGROUND: For an older adult a hip fracture may be a traumatic and life-changing event and has shown to be associated with reduced health-related quality of life, disability and increased mortality. Previous rehabilitation studies have often excluded older adults with cognitive impairment and those living in residential care facilities, groups with an additional risk of poor outcome. Moreover, there are few randomized controlled trials that have evaluated interdisciplinary home rehabilitation after hip fracture. These studies did not include older adults with severe cognitive impairment or dementia, those with serious medical conditions, or those living in residential care.

OBJECTIVE: The aim of the thesis was to investigate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation (GIHR) for older adults with hip fracture, and specifically among those with dementia, compared to in-hospital geriatric care according to a multifactorial rehabilitation program. An additional aim was to explore how older adults experienced their rehabilitation and recovery during the year following the fracture.

METHODS: The thesis evaluated a randomized controlled trial that included 205 participants with hip fracture, 70 years or older, living in ordinary housing or residential care facilities. In hospital, both the GIHR and control groups received care and rehabilitation according to a multifactorial rehabilitation program, but with the aim of early discharge for the GIHR group. The individually designed GIHR intervention focused on walking ability indoors and outdoors, independence in activities of daily living (ADL), and multifactorial fall prevention during a maximum period of 10 weeks. Participants were assessed in-hospital and at 3- and 12-month follow-up visits. Independence in walking and use of walking aids was assessed via an interview along with gait speed tests. Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index, and hospital length of stay (LOS) was recorded from medical charts. The effects of GIHR intervention among participants with dementia were investigated in a post hoc subgroup analysis where additional outcomes were falls, mortality and readmissions between discharge and 12 months. Individual interviews were conducted with 20 selected participants just after the 12-month follow-up. Data were analysed using qualitative content analysis.

RESULTS: The postoperative hospital LOS was significantly reduced by a median of six days in the GIHR group compared to the control group, although not significantly reduced in the GIHR group for participants with dementia. Binary logistic regression analyses revealed no significant differences between the GIHR and control groups regarding independent walking ability, the ability to walk without a walking device, or independence in ADL at 3 and 12 months. Gait speed was comparable between the two groups at 3 and 12 months. At 12 months, 56% in the GIHR group and 58% in the control group had recovered their prefracture walking ability, and 41% vs. 42% in GIHR and control groups, respectively, had regained their prefracture Barthel ADL Index score. Interaction analyses showed that the GIHR group vs. the control group had comparable effects on walking ability and ADL at 3 and 12 months, and on falls and mortality between discharge and 12 months, regardless of whether the participants had dementia or not (P≥0.05 for all). The number of readmissions and hospital days after discharge was comparable between GIHR and control groups for participants with dementia. Overall, dementia was associated with significantly impaired walking ability and greater dependence in ADL at 3 and 12 months and with increased risk of falling and increased mortality between discharge and 12 months compared to participants without dementia. The interviews revealed that access to rehabilitation, provided by skilled staff, and support from others were important for participants’ well-being and recovery. Participants experienced a fundamental change in their self-image after the fracture, and faced a number of difficulties, but strove for independence and used adaptive strategies to find contentment in their lives.

CONCLUSIONS: In older adults with hip fracture, early discharge followed by interdisciplinary home rehabilitation significantly reduced postoperative hospital LOS. Functional recovery during the year following the fracture was nevertheless comparable to in-hospital geriatric care according to a multifactorial rehabilitation program. The GIHR intervention seems to be appropriate also for older adults with dementia since the effects were not different in this subgroup, except for postoperative hospital LOS, which was not significantly reduced in the GIHR group for participants with dementia. Further studies with larger samples are needed to validate these results. Overall, dementia was associated with a substantial negative impact on the outcomes. According to participants’ experiences, receiving rehabilitation and support after the hip fracture seems crucial for successful recovery. Negative psychological reactions were common, suggesting that future interventions should consider both physical and psychological aspects. Different rehabilitation alternatives were appreciated by the participants. Rehabilitation should thus be customised to suit wishes and needs of older adults and may accordingly be carried out in different settings, where rehabilitation in the home can be one suitable alternative. The findings of this thesis indicate that geriatric interdisciplinary home rehabilitation after hip fracture can be an alternative and a complement to in-hospital care and rehabilitation for older adults with and without dementia.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 80
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2112
Keywords
hip fracture, geriatrics, dementia, home rehabilitation, interdisciplinary rehabilitation, walking ability, activities of daily living, recovery, length of stay, accidential falls, qualitative
National Category
Physiotherapy Geriatrics
Research subject
Geriatrics; Orthopaedics
Identifiers
urn:nbn:se:umu:diva-178151 (URN)978-91-7855-424-9 (ISBN)978-91-7855-425-6 (ISBN)
Public defence
2021-01-29, Triple Helix, Universitetsledningshuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-01-08 Created: 2021-01-04 Last updated: 2022-07-25Bibliographically approved

Open Access in DiVA

fulltext(708 kB)1516 downloads
File information
File name FULLTEXT01.pdfFile size 708 kBChecksum SHA-512
1c483c0c1806e689df5499fd5cfe600e1244c9259c52d600236b9a8ba2142f8f9551eaab2b3d8831756f52ec9013c05ec036023faa5532e1cf9b07343ddc04aa
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records

Karlsson, ÅsaLindelöf, NinaOlofsson, BirgittaBerggren, MonicaGustafson, YngveNordström, PeterStenvall, Michael

Search in DiVA

By author/editor
Karlsson, ÅsaLindelöf, NinaOlofsson, BirgittaBerggren, MonicaGustafson, YngveNordström, PeterStenvall, Michael
By organisation
Geriatric MedicineSection of PhysiotherapyDepartment of NursingOrthopaedics
In the same journal
Archives of Physical Medicine and Rehabilitation
Geriatrics

Search outside of DiVA

GoogleGoogle Scholar
Total: 1516 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 390 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf