Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

Shams Dakhil,Ingvild Saltvedt,Leiv Otto Watne,Olav Sletvold,Lars Gunnar Johnsen,Frede Frihagen,Torgeir Bruun Wyller,Eva Skovlund,Pernille Thingstad,Stian Lydersen

doi:10.1186/s12877-021-02152-7

Abstract

BackgroundThe incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).MethodsThis study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.ResultsSeven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.ConclusionsMerged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.

Highlights

The incidence of hip fractures are expected to increase in the following years
The aim of the current study was to assess the effect of our orthogeriatric model on Activities of Daily Living (ADL) – both instrumental Activities of Daily living (ADL) (I-ADL) and basic ADL (B-ADL) - four and twelve months after surgery
In Oslo randomization was based on computergenerated random numbers and was carried out by a statistician not involved in the clinical service

Summary

Introduction

The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. The prefracture functional level of hip fracture patients has been found to be a strong and consistent predictor of short- and long-term rehabilitation outcome [2]. Since the incidence is expected to increase, hip fractures will become a progressively larger public health burden [4,5,6]. Most studies have evaluated the effect based on register data (mortality, length of stay, readmissions) and very few have assessed the effect based on a face-to-face evaluation of the patients in the months following discharge

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