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The effects of habitual functional training on physical functioning in patients after hip fracture: the protocol of the HIPFRAC study.

ABSTRACT: The survivors after hip fracture often report severe pain and loss of physical functioning. The poor outcomes cause negative impact on the person's physical functioning and quality of life and put a financial burden on society. Rehabilitation is important to improve physical functioning after hip fracture. To maintain the continuity in rehabilitation we have an assumption that it is of utmost importance to continue and progress the functional training that already started at the hospital, while the patients are transferred to short-term stays in a nursing home before they are returning to home. The aim presently is to examine the effects of a functional training program, initiated by the physiotherapist and performed by the nurses, on physical functioning while the patients are at short term stays in primary health care.Inclusion and randomization will take place during hospital stay. All patients 65 years or above who have sustained a hip fracture are eligible, except if they have a score on Mini Mental State (MMS-E) of less than 15, could walk less than 10 m prior to the fracture, or are terminally ill. The intervention consists of additional functional training as part of the habitual daily routine during short term stays at nursing homes after discharge from hospital. The primary outcome is physical functioning measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are Timed "Up & Go" (TUG), hand grip strength, activPAL accelerometer, and self-reported measures like new Mobility Score (NMS), Walking Habits, University of California Los Angeles (UCLA) activity scale, Fall efficacy scale (FES), EuroQol health status measure (EQ-5D-5 L), and pain.Issues related to internal and external validity in the study are discussed. The outline for the arguments in this protocol is organized according to the guidelines of the Medical Research Council (MRC) guidance on how to develop and evaluate complex interventions.ClinicalTrials.gov NCT02780076 .

SUBMITTER: Heiberg KE

PROVIDER: S-EPMC5241975 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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The effects of habitual functional training on physical functioning in patients after hip fracture: the protocol of the HIPFRAC study.

Heiberg Kristi Elisabeth KE Bruun-Olsen Vigdis V Bergland Astrid A

BMC geriatrics 20170117 1

<h4>Background</h4>The survivors after hip fracture often report severe pain and loss of physical functioning. The poor outcomes cause negative impact on the person's physical functioning and quality of life and put a financial burden on society. Rehabilitation is important to improve physical functioning after hip fracture. To maintain the continuity in rehabilitation we have an assumption that it is of utmost importance to continue and progress the functional training that already started at t ...[more]

PMID: 28095787

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Project description:IntroductionOlder adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities.MethodsWe conducted a cross-sectional study of 50 older adults (77.1?±?8.1?years old) who underwent hip fracture surgery in the past 4?months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire.ResultsParticipants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5?±?1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability (r?=?-0.41, p?<?0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB (r?=?-0.41, p?<?0.01), and the evaluative category was moderately correlated to ADL and IADL disability (r?=?0.43, p?<?0.01).ConclusionPain can be present 4?months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.

Project description:IntroductionHip fractures are a significant cause of morbidity and mortality and care of hip fracture patients places a heavy burden on healthcare systems due to prolonged recovery time. Measuring quality of care delivered to hip fracture patients is important to help target efforts to improve care for patients and efficiency of the health system. The purpose of this study is to synthesise the evidence surrounding quality of care indicators for patients who have sustained a hip fracture. Using a scoping review methodology, the research question that will be addressed is: "What patient, institutional, and system-level indicators are currently in use or proposed for measuring quality of care across the continuum for individuals following a hip fracture?".Methods and analysisWe will employ the methodological frameworks used by Arksey and O'Malley and Levac et al. The synthesis will be limited to quality of care indicators for individuals who suffered low trauma hip fracture. All English peer-reviewed studies published from the year 2000-most recent will be included. Literature search strategies will be developed using medical subject headings and text words related to hip fracture quality indicators and the search will be peer-reviewed. Numerous electronic databases will be searched. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. Abstracted data will include study characteristics and indicator definitions.DisseminationTo improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required. The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Knowledge translation activities will occur throughout the review with dissemination of the project goals and findings to local, national, and international stakeholders.

Project description:OBJECTIVES:To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN:Retrospective cohort study. SETTING:Academic hospital with ambulatory follow-up. PARTICIPANTS:Community-dwelling adults 65?years or older independent in ADLs undergoing hip fracture surgery in 2015 (n?=?184). MEASUREMENTS:Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS:Predictors of new ADL disability at 3?months were dementia (odds ratio [OR]?=?11.81; P?=?.001) and in-hospital delirium (OR?=?4.20; P?=?.002), and at 6 months were age (OR?=?1.04; P?=?.014), dementia (OR?=?9.91; P?=?.001), in-hospital delirium (OR?=?3.00; P?=?.031) and preadmission opiates (OR?=?7.72; P?=?.003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR?=?4.48; P?=?.001) and number of medications (OR?=?1.13; P?=?.003), and at 6 months were age (OR?=?1.06; P?=?.001), preadmission opiates (OR?=?7.23; P?=?.005), in-hospital delirium (OR?=?3.10; P?=?.019), and number of medications (OR = 1.13; P?=?.013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR?= 1.07; P?=?.014; 6 months: OR?=?1.06; P?=?.017) and number of medications (3 months: OR?=?1.13; P?=?.004; 6 months: OR?=?1.22; P?=?.013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION:Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.

Project description:The HiBalance program is a progressive and highly challenging balance training intervention incorporating Parkinson's disease (PD) specific balance components. The program improves balance and gait and increases the amount of ambulation in short-term, in older adults with PD. Yet, potential short- and long-term effects on habitual physical activity and sedentary behavior are currently unidentified. The aim of this study was to conduct preplanned secondary analyses of short- and long-term effects of the HiBalance program on objectively measured amount and bouts of brisk walking, sedentary behavior, and total physical activity in older adults with PD. Further, our aim was to investigate demographic, intervention-related, disease-related, and function-related factors potentially related to a difference in activity after intervention. A total of 100 older adults with mild-moderate PD were recruited. The intervention group participated in the HiBalance program, and the control received care as usual and was offered the HiBalance program after study termination. Physical activity data were collected using accelerometers at baseline, after intervention and after 6 and 12 months. A multilevel model was utilized to investigate the postintervention and long-term (6 and 12 months) effects on total physical activity, amount and bouts of brisk walking (i.e., moderate intensity physical activity), and sedentary behavior. Between-group difference for the main outcome brisk walking was at postintervention: Δ -10, CI -23.78 to 3.69 min/day (p < 0.05); 6 months: Δ -10, CI -23.89 to 3.89 min/day (p < 0.05); and 12 months: Δ -4, CI -16.81 to 8.81 min/day (p=0.43). Being part of the intervention group as well as finishing training during spring/summer showed an independent association to increased brisk walking after the intervention period. In conclusion, the HiBalance program increases the physical activity on moderate intensity after intervention and at 6 months but not at 12 months, independently of improved balance. Season seems to influence the effect on the physical activity.

Dataset Information

The effects of habitual functional training on physical functioning in patients after hip fracture: the protocol of the HIPFRAC study.

Publications

The effects of habitual functional training on physical functioning in patients after hip fracture: the protocol of the HIPFRAC study.

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