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Randomized Controlled Trial
. 2019 May 1;48(3):373-380.
doi: 10.1093/ageing/afz005.

Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial

Maria Crotty  1 , Maggie Killington  1 , Enwu Liu  1   2 , Ian D Cameron  3 , Susan Kurrle  4 , Billingsley Kaambwa  5 , Owen Davies  1 , Michelle Miller  6 , Mellick Chehade  7   8   9 , Julie Ratcliffe  10
Affiliations
Randomized Controlled Trial

Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial

Maria Crotty et al. Age Ageing. .

Abstract

Objective: to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care.

Design: parallel randomised controlled trial with integrated health economic study.

Setting: NCFs, in Adelaide South Australia.

Subjects: people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture.

Measurements: primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months.

Results: participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference -1.9; 95% CI: -3.3, -0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = -7.4; 95% CI: -12.5 to -2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: -0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056).

Conclusions: the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective.

Trial registration: ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 361980.

Keywords: aged care; hip fracture; mobility; older people; quality of life; rehabilitation.

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Figures

Figure 1.
Figure 1.
Survival probability from randomisation to 12-month follow-up.
See this image and copyright information in PMC

References

    1. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51: 364–70. - PubMed
    1. Neuman MD, Silber JK, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med 2014; 174: 1273–80. - PMC - PubMed
    1. National Institute of Clinical Excellence (NICE) The management of hip fracture in adults. London 2011; Available from: http://www.nice.org.uk/nicemedia/live/11968/51532/51532.pdf.
    1. Crocker T, Forster A, Young J et al. . Physical rehabilitation for older people in long-term care. Cochrane Database Syst Rev 2013; 28: CD004294. - PMC - PubMed
    1. Australian and New Zealand Hip Fracture Registry (ANZHFR) Steering Group Australian and New Zealand Guideline for Hip Fracture Care: Improving Outcomes in Hip Fracture Management of Adults. Sydney: Australian and New Zealand Hip Fracture Registry Steering Group, 2014.

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