Authors (including presenting author) :
CWL Tsoi (1)*, C Fang (2), CSY Yung (2), KY Chan (2), CC Tsang (1), TKC Wong (1), F Hu (1), R Leung(1), KY Wan (3), YL Ng (3), YK Cheng (4), KK Fung (5), TM Wong (2), TW Lau (2), FKL Leung (2)
* Presenter
Affiliation :
(1) Physiotherapy Department, MacLeohose Medical Rehabilitation Center, Hong Kong West Cluster
(2) The Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong
(3) Occupational Therapy, Macleohose 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 enormous healthcare problem with many unable to return to their premorbid status. The transitional impact from in-patient to out-patient in the early discharge period is understudied and often neglected.
Objectives :
A Caregiver Empowerment Programme (CEP) was developed and aimed to promote effective self-help home rehabilitation via enhanced skills, manpower utilization, confidence, and knowledge. Its’ effects on physical recovery was studied in a randomized control trial.
Methodology :
Hip fractures >50 years of age with identifiable caregivers were recruited from 9/2019 to 1/2022. They were block randomized to either control group receiving conventional rehabilitation or the intervention group receiving CEP when deemed fit for rehabilitation. Therapists gave face-to-face training to patients and their caregivers as well as providing task-specific online multimedia tutorials in a structured rehabilitation programme. Physiotherapists focused on mobility training and safety. Physical assessment was performed using the Timed-Up and Go (TUG) test at discharge, 2 months, 6 months and 1 year intervals.
Result & Outcome :
Results：
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).
Physical improvement with the TUG test showed improvement in walking speeds for the interventional group at 6 months (control: 175 seconds median versus intervention: 78.8 seconds for completion of TUG test, p=0.001). This is further exemplified when time to completion in TUG test within 60 seconds is compared. At 6-months, 68.3% of the patients in the intervention arm were able to complete the TUG test within 1-minute compared to 31.7% in the control arm (RR=1.89, p=0.001). A Number Needed to Treat (NNT) of 3.11 was achieved.
Outcomes:
The interventional programme introduced here helps solve the gap in rehabilitation following hospital discharge and empowers caregivers to assist and monitor the rehabilitation for their loved ones. Caregivers can perform rehabilitative exercises at home with perceived safety and confidence. The result from this study demonstrates that caregiver empowerment leads to significantly improved physical recovery with TUG test showed exceptional benefit at 6-months with participants are nearly twice as likely able to complete an independent six-meter walk within 1-minute. The implementation of a structured CEP is recommended to all rehabilitation institutions for geriatric hip fractures to bridge the gap between discharge and home.
