Abstract
BackgroundLittle is known about treatment provided to people living in nursing care facilities (NCFs) after hospital admission for hip fracture. In addition, there are no clinical guidelines for rehabilitation and recovery following hip fracture for nursing home residents.MethodsAs part of a randomised trial (SACRED trial), which investigated the efficacy of a four week in-reach rehabilitation program, data were collected which described routine care for 240 people living in 76 nursing care facilities in South Australia who fractured their hips. The in-reach rehabilitation provided to 119 intervention participants is described, including intensity, type and methods used to encourage participation in rehabilitation. Adverse events that occurred, in particular falls, are also reported.ResultsNCF records indicated that, over the four weeks following discharge from hospital after hip fracture, 76% of patients receiving usual care had a consultation with their general practitioner. Physiotherapy was provided to 79% of patients in usual care (median of 1.96 h over the 4 weeks, which is less than 30 min each week of physiotherapy). In-reach rehabilitation was provided by the hospital team for 13 h over the 4 weeks with almost full attendance at physiotherapy sessions (median of 1 missed session, range 0–7 with a median of 14 physiotherapy sessions attended by participants, range 1–18). Experienced therapists provided a flexible approach to the rehabilitation to account for patients’ dementia and associated neuropsychiatric symptoms while providing dietetic support, mobility training and education to nursing home staff. The number of falls experienced by those in the intervention group was higher compared to those in usual care (Relative Risk 1.38 (95%CI 1.04–1.84, p = 0.03).ConclusionsRehabilitation can be provided to people living in NCFs following hip fracture, even when they have moderate to severe dementia but the model needs to be flexible. Provision of rehabilitation may increase the rate of falls in this population. Further studies are required to establish the feasibility of the intervention in other long term care settings. (327 words).Trial registrationACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR).
Highlights
Little is known about treatment provided to people living in nursing care facilities (NCFs) after hospital admission for hip fracture
People living in nursing care facilities (NCFs) are often excluded from participating in research and clinical trials [1] which has contributed to a lack of information regarding the usual clinical care provided in NCFs to residents following their return from hospital after hip fracture surgery
While there is evidence suggesting that rehabilitation following hip fracture repair improves outcomes and that this rehabilitation is best provided as part of an organised multidisciplinary health care team it is unclear how services should be provided to people living in NCFs, the majority of whom have dementia [2, 3]
Summary
Little is known about treatment provided to people living in nursing care facilities (NCFs) after hospital admission for hip fracture. People living in nursing care facilities (NCFs) are often excluded from participating in research and clinical trials [1] which has contributed to a lack of information regarding the usual clinical care provided in NCFs to residents following their return from hospital after hip fracture surgery. This lack of information makes the development of practice guidelines difficult. Little is known about what types of therapy and how much therapy people who live in residential aged care are receiving following a hip fracture It is unclear whether they will tolerate team based rehabilitation approaches
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