The proposed project is part of an ongoing program of research to develop evidence-based practice for occupational therapy and physical therapy in subacute rehabilitation. Two distinct approaches to therapy are routinely practiced: (a) a functional approach involving participation in daily living tasks; and (b) a rote exercise approach whereby the patient is instructed to follow exercise protocols. In the proposed project, these two approaches will be compared in subacute rehabilitation patients with hip fracture. Subacute rehabilitation is a neglected site for research, even though it is one of the most common settings for therapy practice. Hip fracture, frequently occurring in frail elderly persons with multiple health problems, is one of the most important diagnoses in this setting. The two specific aims are to determine if there is a difference between the functional approach to rehabilitation and the rote exercise approach to rehabilitation in terms of improvement in (a) the motor abilities required for daily living tasks, and (b) self-reported physical health status. The design is a randomized trial (pretest-posttest design) with blind assessment of outcomes. The final sample size of 104 provides adequate power. The two dependent variables are derived from the Assessment of Motor and Process Skills and the SF-36. Protocols for the two interventions include specifications for each intervention as well as lists of daily living tasks or exercises appropriate to each intervention. Pre-training and ongoing training of interventionists emphasizes equivalent attention and balance across conditions while preventing inadvertent contamination across conditions. Intervention fidelity will be tested by an independent, blind reviewer of clinical notes.
Each specific aim will be tested by analysis of covariance, with the pretest as a covariate and with other relevant covariates including co-morbidities, cognitive status, hours of therapy, age, and gender. Alpha will be set at .05 for a two-tailed test. The proposed project follows logically from a smaller project funded by the American Occupational Therapy Foundation, and leads logically to a multi-site clinical trial of these two commonly used but untested approaches to rehabilitation.
