A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture

Abstract

Objective: To compare ambulation outcomes between home and institutional rehabilitation of patients with hip fracture.

Design: Randomized controlled clinical equivalence trial.

Setting: The Queen Elizabeth Hospital in Hong Kong.

Subjects: Eighty-one patients with hip fracture.

Intervention: Study group patients (40) were discharged directly home from the acute hospital and visited by a physiotherapist an average of 4.6 times. The control group subjects (41) were discharged to a rehabilitation centre for further treatment lasting on average 36.2 days (SD 14.6) and they received physiotherapy daily.

Main outcome measures: Ambulation ability measured on a categorical scale.

Results: The mean age of the subjects was 75 years (SD 8.3 years). Females comprised 60% of all the subjects and majority were retired or home makers. Both groups of patients improved in their ambulation ability during their rehabilitation period but neither group achieved their pre-ambulatory status by the time of completion of the study. The study group achieved significantly higher ambulation scores (p < 0.05) for community and household ambulation compared with the control group by the end of the study, a year after operation.

Conclusion: Five visits by a physiotherapist in the patient's home after discharge from an acute hospital after surgical treatment for hip fracture yielded better results in ambulation ability than one month of conventional institution-based rehabilitation.