The Library
Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study : Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)
Tools
Williams, Nefyn H., Roberts, Jessica L., Din, Nafees Ud, Charles, Joanna M., Totton, Nicola, Williams, Michelle, Mawdesley, Kevin, Hawkes, Claire, Morrison, Val, Lemmey, Andrew, Edwards, Rhiannon T., Hoare, Zoe, Pritchard, Aaron W., Woods, Robert T., Alexander, Swapna, Sackley, Catherine, Logan, Pip, Wilkinson, Clare and Rycroft-Malone, Jo (2017) Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study : Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technology Assessment, 21 (44). pp. 1-528. doi:10.3310/hta21440 ISSN 1366-5278.
|
PDF
WRAP-developing-multidisciplinary-rehabilitation-package-Hawkes-2017.pdf - Published Version - Requires a PDF viewer. Download (39Mb) | Preview |
Official URL: http://dx.doi.org/10.3310/hta21440
Abstract
Background
Proximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.
Objectives
To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.
Design
Phase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.
Setting
Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.
Participants
Older adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.
Interventions
Participants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.
Main outcome measures
The primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.
Results
Sixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control, n = 32; intervention, n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’s d = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’s d = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’s d = 0.31) and 1.3 (Cohen’s d = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.
Conclusions
Trial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.
Item Type: | Journal Article | ||||||
---|---|---|---|---|---|---|---|
Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit | ||||||
Library of Congress Subject Headings (LCSH): | Femur -- Fractures -- Treatment, Femur -- Surgery -- Rehabilitation -- Cost effectiveness, Older people -- Medical care, Clinical trials | ||||||
Journal or Publication Title: | Health Technology Assessment | ||||||
Publisher: | NIHR Health Technology Assessment programme | ||||||
ISSN: | 1366-5278 | ||||||
Official Date: | August 2017 | ||||||
Dates: |
|
||||||
Volume: | 21 | ||||||
Number: | 44 | ||||||
Page Range: | pp. 1-528 | ||||||
DOI: | 10.3310/hta21440 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 5 September 2017 | ||||||
Date of first compliant Open Access: | 6 September 2017 | ||||||
Funder: | National Institute for Health Research Health Technology Assessment (Great Britain) (NIHR HTA) |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |
Downloads
Downloads per month over past year