Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Odense, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Trials. 2022 May 7;23(1):375. doi: 10.1186/s13063-022-06321-w.
A hip fracture is a serious event for older adults, given that approximately 50% do not regain their habitual level of physical function, and the mortality rate is high, as is the number of readmissions. The gap in healthcare delivery, as separated into two financial and self-governing sectors, might be a contributing cause of inferior rehabilitation and care for these patients. Therefore, we aim to assess the effect of continuous and progressive rehabilitation and care across sectors for older adults after hip fracture.
METHODS/DESIGN: The project is designed as a stepped-wedge cluster randomised controlled trial. The study population of patients are older adults 65 years of age and above discharged after a hip fracture and healthcare professionals in primary and secondary care (municipalities and hospitals). Healthcare professionals from different sectors (hospital and municipalities) will be engaged in the empowerment-orientated praxis, through a workshop for healthcare professionals with knowledge sharing to the older adults using a digital health application (app). The rehabilitation intervention consists of 12 weeks of progressive resistance exercises initiated 1-2 days after discharge. To improve communication across sectors, a videoconference involving the patient and physiotherapists from both sectors will be conducted. On day, 3 after discharge, an outreach nurse performs a thorough assessment including measurement of vital signs. A hotline to the hospital for medical advice is a part of the intervention. The intervention is delivered as an add-on to the usual rehabilitation and care, and it involves one regional hospital and the municipalities within the catchment area of the hospital. The primary outcome is a Timed Up and Go Test 8 weeks post-surgery.
Using a stepped-wedge design, the intervention will be assessed as well as implemented in hospital and municipalities, hopefully for the benefit of older adults after hip fracture. Furthermore, the collaboration between the sectors is expected to improve.
The study is approved by the Regional Scientific Ethics Committees of Southern Denmark (S-20200070) and the Danish Data Protection Agency (20-21854). Registered 9 of June 2020 at ClinicalTrials.gov, NCT04424186 .
髋部骨折对老年人来说是一个严重的事件，因为大约有 50%的老年人无法恢复到他们惯常的身体功能水平，且死亡率和再入院率都很高。医疗保健服务的提供存在差距，分为两个财务和自治部门，这可能是导致这些患者康复和护理质量下降的一个原因。因此，我们旨在评估跨部门为髋部骨折后老年人提供连续和渐进式康复和护理的效果。
方法/设计：该项目设计为一个阶梯式楔形集群随机对照试验。研究人群为年龄在 65 岁及以上、髋部骨折出院后的老年人和初级及二级保健（市和医院）的医疗保健专业人员。来自不同部门（医院和市）的医疗保健专业人员将通过一个面向赋权的实践工作坊参与进来，该工作坊将为老年人提供知识共享，并使用数字健康应用程序（app）为他们提供康复干预。康复干预包括在出院后 1-2 天开始的 12 周渐进式抗阻运动。为了改善跨部门的沟通，将进行一次包括来自两个部门的患者和物理治疗师的视频会议。在出院后第 3 天，一名外展护士进行全面评估，包括测量生命体征。医院的热线电话提供医疗建议是干预措施的一部分。该干预措施作为常规康复和护理的附加措施提供，涉及一家区域医院和该医院的辖区内的市。主要结局是术后 8 周的计时起立行走测试。
使用阶梯式楔形设计，将评估干预措施的效果并在医院和市实施，希望能使髋部骨折后的老年人受益。此外，预计两个部门之间的合作将得到改善。
该研究得到了南丹麦地区科学伦理委员会（S-20200070）和丹麦数据保护局（20-21854）的批准。于 2020 年 6 月 9 日在 ClinicalTrials.gov 注册，NCT04424186。
