Authors (including presenting author) :
Ng YL(1), Fang C(2), Yung CSY(2), Chan KY(2), Tsoi L(3), Tsang CC(3), Wan KY(1), Cheng YK(4), Fung KK(5), Wong TM(2), Lau TW(2), Leung FKL(2)
Affiliation :
(1) Occupational Therapy, MacLehose Medical Rehabilitation Center, Hong Kong West Cluster
(2) The Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong
(3) Physiotherapy Department, MacLehose Medical Rehabilitation Center, Hong Kong West Cluster
(4) Physiotherapy Department, Fung Yiu King Hospital, Hong Kong West Cluster
(5) Occupational Therapy, Fung Yiu King Hospital, Hong Kong West Cluster
Introduction :
Geriatric hip fracture is an important healthcare issue with only 60% of patients able to return home with many becoming institutionalized. Majority of patients develop moderate to severe functional dependency in activities of daily living (ADL). Caregiver Empowerment is an emerging concept aiming to tackle patient vulnerabilities immediately after their return home. Systematic training is geared towards the patient-caretaker synergism before discharge. A structured, health-care professional delivered, Caregiver Empowerment Programme (CEP) was developed to promote effective self-help home rehabilitation. A randomized control trial was designed to study its’ effects on patient’s functional recovery after discharge.
Objectives :
This study aimed to evaluate the effect of CEP on patient's functional recovery after discharge
Methodology :
Patients with acute geriatric hip fractures that had identifiable caregivers willing to take care of the patient after discharge were recruited from 9/2019 to 1/2022. They were block randomized to either control group receiving conventional rehabilitation and pre-discharge program, whereas the intervention group receiving additional CEP. Occupational therapists arranged face-to-face ADL facilitation and caring skills training sessions including transfer, bathing and dressing. Online task specific multimedia on such topics were also provided. Functional skills were assessed and reinforced before discharge. Outcomes with the MBI score was recorded at discharge, 2 month, 6 month and 1 year interval.
Result & Outcome :
125 patients were randomized into two groups (64 in control and 61 in intervention). Baseline characteristics showed no statistical differences in age (mean 85-years-old, p=0.80), sex (F 76%: M 24%, p-value 0.33), premorbid AMT (control: 6.14 vs. intervention: 7.42, p=0.14) and premorbid MBI (control: 94.9 vs intervention: 95.7, p=0.69).
Superior functional performance in the interventional group (CEP) versus the control group was seen with higher MBI scores at all timepoints, statistical significance was reached at 6-months (control: 76.1 vs. intervention: 87.7, p=0.026). Results demonstrated patients who undergone Caregiver Empowerment Programme have better perceived health when compared to control patients.
Discussion:
The impact of caregiver empowerment has not been studied in geriatric hip fractures before. The interventional programme introduced here empowers caregivers for basic ADL facilitation and caring for their loved ones. The result from this study clearly demonstrates that CEP leads to significantly improved early to mid-term functional and quality of life outcomes. The implementation of a structured Caregiver Empowerment Programme is strongly recommended to all rehabilitation institutions for geriatric hip fractures to bridge the gap between discharge and home rehabilitation.
