Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
Academic Unit, Peninsula Health, Frankston, Victoria, Australia.
BMJ Open. 2021 Nov 23;11(11):e054298. doi: 10.1136/bmjopen-2021-054298.
Guidelines for hip fracture care state that patients with hip fracture should be mobilised on the day after surgery and at least once a day thereafter. However, compliance with these guidelines is poor. One approach that would assist physiotherapists to meet mobility guidelines after hip fracture is to delegate the provision of daily mobilisation to allied health assistants under their supervision. Therefore, we plan to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient rehabilitation to patients with hip fracture.
Using a parallel group randomised controlled design with one-to-one allocation, participants will be randomly allocated to an experimental group (allied health assistant management) or a comparison group (physiotherapist management). Inclusion criteria are: adult with diagnosis of hip fracture; inpatient in acute hospital; walked independently pre-hip fracture and able to communicate in conversational English. The experimental group will receive routine physiotherapy rehabilitation, including daily mobilisation, from an allied health assistant following initial physiotherapist assessment. The comparison group will receive routine rehabilitation from a physiotherapist. The primary outcome will be the feasibility of allied health assistant management of patients with hip fracture. Feasibility will be determined using the following areas of focus in Bowen's feasibility framework: acceptability (patient satisfaction), demand (proportion of patients who participate), implementation (time allied health assistant/physiotherapist spends with participant, occasions of service) and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant care will be interviewed to explore their perspectives on feasibility. Secondary outcomes include compliance with daily mobilisation guidelines, discharge destination, hospital readmission, falls, functional activity and length of stay. We aim to recruit 50 participants. Descriptive statistics will be used to describe feasibility and mobilisation rates will be calculated using Cox proportional hazards regression to compare compliance with mobilisation guidelines.
Ethics approval was obtained from the Peninsula Health human research ethics committee (HREC/63 005/PH-2020). The findings will be disseminated in peer-reviewed journals and conference presentations.
Australian and New Zealand Clinical Trial Registry; ACTRN12620000877987; Pre-results.
髋部骨折护理指南指出，髋部骨折患者应在手术后的第二天开始活动，并在此后的至少每天活动一次。然而，这些指南的遵循情况很差。一种有助于物理治疗师在髋部骨折后满足活动指南的方法是，在他们的监督下，将日常活动的提供委托给辅助医疗助理。因此，我们计划进行一项随机对照试验，以确定辅助医疗助理为髋部骨折患者提供每日住院康复的可行性。
采用平行组随机对照设计，一对一分配，将参与者随机分配到实验组（辅助医疗助理管理）或对照组（物理治疗师管理）。纳入标准为：成人髋部骨折诊断；急性医院住院；髋部骨折前独立行走，能够用会话英语进行沟通。实验组将在初始物理治疗师评估后接受辅助医疗助理提供的常规物理治疗康复，包括每日活动。对照组将接受物理治疗师的常规康复。主要结局将是髋部骨折患者辅助医疗助理管理的可行性。将使用 Bowen 可行性框架的以下重点领域来确定可行性：可接受性（患者满意度）、需求（参与患者的比例）、实施（辅助医疗助理/物理治疗师与参与者共度的时间、服务次数）和实用性（成本、不良事件）。将对参与辅助医疗助理护理实施的工作人员进行访谈，以探讨他们对可行性的看法。次要结局包括对日常活动指南的依从性、出院去向、医院再入院、跌倒、功能活动和住院时间。我们的目标是招募 50 名参与者。将使用描述性统计来描述可行性，并用 Cox 比例风险回归来计算活动率，以比较对活动指南的依从性。
该研究已获得半岛健康人体研究伦理委员会（HREC/63 005/PH-2020）的批准。研究结果将在同行评议的期刊和会议报告中发表。
澳大利亚和新西兰临床试验注册中心；ACTRN12620000877987；预结果。
