Over 250,000 patients are hospitalized each year in the United States for a fractured hip, with treatment and rehabilitation costs exceeding $7 billion per year.
The specific aims of this project are to: a) implement an intervention program of patient education focused on self-efficacy and strength training designed to improve the postoperative rehabilitation of older persons (> 65 years of age) who have sustained a fracture of the hip; and b) evaluate in a prospective randomized trial the efficacy of this intervention program to improve the overall postoperative functional status of such patients and decrease the rate of their subsequent institutionalization. The study will also a) describe and document the risk factors for functional deterioration, recurrent falls, and subsequent institutionalization in a cohort of such patients; b) assess self-efficacy beliefs and their ability to influence and predict postoperative functional capacity in such patients; and c) document the costs associated with the implementation of the program and to generate data that can provide the basis for subsequent cost-benefit analysis. We hypothesize that a) a program of patient education focusing on self- efficacy and strength training can improve the functional capacity and reduce the rate of institutionalization of older persons following hip fracture; and b) clinical, psychosocial factors, muscle strength and balance are multifactorial determinants of functional capacity, recurrent falls, and subsequent institutionalization in hip fracture patients. We will randomize 200 patients who have sustained a primary unilateral hip fracture to the multiple-component intervention program of patient education and high-intensity strength training or to standard medical care. The intervention program will comprise four major components: (1) an in-hospital postoperative patient instruction protocol conducted prior to discharge with the patient and a family member or caregiver; (2) a hospital-based, 8-week program of high-intensity isokinetic strength training for patients; (3) an at-home walking program designed to enable patients to maintain strength and physical activity following the hospital-based portion of the intervention; and (4) supportive telephone calls through which patients and their families or caregivers will have regular and ongoing contact with a hospital-based interventionist, as well as other hip fracture patients. The principal outcome is within patient change in the physical, social and role function subscales of the SF36. Secondary measures of outcome include muscle strength, balance, functional status on the Cummings scale, activities of daily living, recurrent falls, and rate of institutionalization will be assessed at baseline and one year postdischarge. The long-term objective of the project is to improve the overall functional capacity and reduce both recurrent falls and the need for institutionalization of hip fracture patients through development and evaluation of an intervention program whose feasibility and cost has the potential for application in a wide range of institutional settings involved in the treatment and rehabilitation of such patients.
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