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Completed

NCT Number: NCT03906864

Care Pathway for Sub-acute Hip Rehabilitation

The effectiveness of integrated care pathways for hip fractures in sub-acute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a sub-acute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. A randomised controlled trial on an integrated care pathway was conducted for hip fracture patients in a sub-acute rehabilitation setting. The study supports the use of integrated care pathways in sub-acute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.

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Key information

Conditions

Hip Fractures Femoral Fractures Fractures, Bone Hip Injuries Leg Injuries Wounds and Injuries

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

St Luke's Hospital, Singapore

Singapore, 659674

About this study

All patients admitted to St Luke's Hospital, a 185-bed hospital in Singapore providing multidisciplinary stepdown care, from 8 September 2004 to 14 June 2006 for the purpose of rehabilitation after a new hip fracture were included. Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial. Administrative staff allocated patients to either ICP or usual care according to the last digit of their National Registration Identity Card (NRIC) numbers, odd numbers to the intervention group and even numbers to the control group. Patients were then admitted to 1 of 2 intervention wards or 1 of 3 control wards. Patients were enrolled by the principal investigators only after moving into their respective wards because of work flow limitations. Those who refused consent or were excluded remained in their assigned wards and received usual care. Both intervention and control groups were under the care of multidisciplinary teams but the intervention group had structured assessments and checklists in addition to usual care while the control group had usual care alone.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients admitted to St Luke's Hospital for the purpose of rehabilitation after a new hip fracture.

Exclusion criteria

  • Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial.

Treatment and study plan

Care pathway

Other

The intervention group had the following as part of the integrated care pathway:

  • Medical assessment on admission for risk factors for falls.
  • A weekly assessment of complications including pain, deep venous thrombosis, anaemia, wounds and pressure ulcers, etc. The Confusion Assessment Method and the Geriatric Depression Scale were utilized.
  • Physiotherapy and occupational therapy guidelines with recommended milestones (set for the full, partial and non-weight bearing groups)
  • Physiotherapy Clinical Outcome Variables Scale (PTCOVS)16 was used by the physiotherapists in the intervention group to assess the baseline mobility, to define outcome goals and to direct treatment plans.
  • A postoperative hip precaution handout (containing information on avoiding hip prosthesis dislocation in patients with total hip replacement or hemiarthroplasty) was given to patients and their caregivers.

Primary outcomes

  1. Montebello Rehabilitation Factor Score (MRFS)

    Time frame: 1 day At discharge

    MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100)

  2. Montebello Rehabilitation Factor Score (MRFS)

    Time frame: At 6 months

    MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100)

  3. Montebello Rehabilitation Factor Score (MRFS)

    Time frame: At 1 year

    MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100)

  4. Proportions of patients achieving pre-morbid ambulatory status

    Time frame: 1 day At discharge

    Pre-morbid ambulatory status is a predictor for post-operative mobility

  5. Proportions of patients achieving pre-morbid ambulatory status

    Time frame: At 6 months

    Pre-morbid ambulatory status is a predictor for post-operative mobility

  6. Proportions of patients achieving pre-morbid ambulatory status

    Time frame: At 1 year

    Pre-morbid ambulatory status is a predictor for post-operative mobility

  7. Length of stay in hospital

    Time frame: 1 day At discharge

    Refers to the average number of days that patients spend in hospital

  8. Percentage of patients admitted to nursing home

    Time frame: Up to 1 year after discharge

    A form of institutional care

Secondary outcomes

  1. Readmissions to an acute hospital for any reason

    Time frame: up to 1-year post-discharge

    An episode when a patient who had been discharged from a hospital is admitted again within a specified time interval

  2. Cumulated mortality

    Time frame: 1 year

    Probability or risk of individuals dying from the disease during a specified period

  3. Quality of life scale-Short form 12 quality of life

    Time frame: 6 months and 1 year

    Scale for short form 12 quality of life 0-100

    Scale for Physical Component Summary (PCS) and Scale for Mental Component Summary (MCS), a multipurpose, generic measure of health status 0-100

    Interpretation of the score : The higher score, the better

Sponsors and collaborators

Lead sponsor

St Luke's Hospital, Singapore

Other

Collaborators

  • National University of Singapore

Registry information

Official study title

Integrated Care Pathway for Hip Fractures in a Subacute Rehabilitation Setting

Important dates

Study start
2004
Primary completion
2006
Study completion
2012
First posted
Apr 8, 2019
Registry last updated
Apr 8, 2019

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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