Early discharge and home rehabilitation after hip fracture achieves functional improvements

a randomized controlled trial

Crotty, Maria
Whitehead, Craig H
Gray, Steven
Finucane, Paul M

Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daw Park, Australia

Address for correspondence: Maria Crotty, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park 5041, Australia. e-mail: [email protected]

Received 7th August 2001; returned for revisions 26th October 2001; revised manuscript accepted 5th December 2001.

Clinical Rehabilitation 16(4):p 406-413, April 2002.

Objective

To compare hospital and home settings for the rehabilitation of patients following hip fracture.

Design

Randomized controlled trial comparing accelerated discharge and home-based rehabilitation (n = 34) with conventional hospital care (n = 32) for patients admitted to hospital with hip fracture.

Setting

Three metropolitan hospitals in Adelaide, Australia.

Subjects

Sixty-six patients with fractured hip.

Interventions

Patients assigned to the home-based rehabilitation group were discharged within 48 hours of randomization. The project team therapists made visits to the patient's home and negotiated a set of realistic, short-term and measurable treatment goals with both the patient and carer. Those randomized to usual care remained in hospital for conventional rehabilitation.

Main outcome measures

Physical and social dependence, balance confidence, quality of life, carer strain, patient and carer satisfaction, use of community services and incidence of adverse events such as re-admission and falls.

Results

While there was no difference between the groups for all measures of quality of life, patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from randomization (p < 0.05) and scored higher on the Falls Efficacy Scale (p < 0.05) at four months. There was no difference in falls rates. Patients in the home-based rehabilitation group had a shorter stay in hospital (p < 0.05) but a longer stay in rehabilitation overall (p < 0.001). The groups were comparable on the rate and length of admissions after discharge, use of community services, need for carer input and contact with general practitioner (GP) after discharge.

Conclusions

This trial further supports the practice of accelerated discharge from hospital and home-based rehabilitation in selected patients recovering from hip fracture. Such a practice appears to improve physical independence and confidence in avoiding subsequent falls which may have implications for longevity and overall quality of life.