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Allied health assistant management of people with hip fracture is feasible and may improve patient adherence to hip fracture mobilisation guidelines: a feasibility randomised controlled trial [with consumer summary]
Snowdon DA, Vincent P, Callisaya ML, Collyer TA, Brusco NK, Wang YT, Taylor NF
Physiotherapy 2024 Sep;124:51-64
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: Determine the feasibility of allied health assistant (AHA) management of people with hip fracture an acute hospital. DESIGN: Assessor-blind, parallel, feasibility randomised controlled trial with qualitative component. SETTING: Acute orthopaedic ward. PARTICIPANTS: People with surgically-managed hip fracture, who walked independently pre-fracture and had no cognitive impairment. INTERVENTIONS: Rehabilitation from an AHA, under the supervision of a physiotherapist, compared with rehabilitation from a physiotherapist. MAIN OUTCOME MEASURES: Feasibility was evaluated according to focus areas of demand, acceptability, practicality and implementation. Secondary outcomes included estimates of effect of adherence to hip fracture mobilisation guidelines, discharge destination, 30-day readmission, functional activity, and length of stay. RESULTS: Fifty people were allocated to receive rehabilitation from an AHA (n = 25) or physiotherapist (n = 25). AHA rehabilitation had high demand with 60% of eligible participants recruited. Satisfaction with AHA rehabilitation was comparable with physiotherapy rehabilitation (acceptability). The AHA group received an average of 11min (95% CI 4 to 19) more therapy per day than the physiotherapy group (implementation). The AHA group may have had lower cost of acute care (MD -$3808 95% CI -7 651 to 35) and adverse events were comparable between groups (practicality). The AHA group may have been 22% (HR 1.22, 95% CI 0.92 to 1.61) more likely to walk on any day and may have had a shorter length of stay (MD -0.8 days, 95% CI -2.3 to 0.7). CONCLUSIONS: AHA management of patients with hip fracture was feasible and may improve adherence to mobilisation guidelines and reduce cost of care and length of stay. CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12620000877987.

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