The incidence, mortality, cost, loss of function, and need for institutionalization associated with hip fractures are increasingly well recognized. Hip fracture patients who return home often receive little post discharge rehabilitation. The objective of this intervention study, therefore, is to test a home-based rehabilitation strategy for improving the functional status among community-living elderly persons who suffer a hip fracture. All eligible, consenting persons greater than 65 years of age, discharged to a non-institutional setting from the two acute hospitals in New Haven after surgical repair for hip fracture will be randomized, using a stratified block design, to receive either """"""""usual post hospital care"""""""" (UC) or a home-based multidomain rehabilitation intervention strategy (HMR). Functional level as well as physical performance, life satisfaction, depressive symptoms, and efficacy will be assessed in both groups at 6 and 12 months after hospital discharge. Falls, serious injuries, and health care utilization will be monitored throughout follow-up. The components of the intervention strategy include: 1) strength and ROM exercise; 2) balance, gait, transfer, stair climbing, and hand task instruction and exercises; 3) instruction in safe, effective techniques for ADL and IADL performance; 4) adaptive equipment; and 5) home adaptations.
The specific aims of this project are: 1) to determine whether a """"""""home- based multidomain rehabilitation"""""""" intervention strategy (HMR) results in greater improvements in functional level than """"""""usual care"""""""" (UC) among community-living elderly persons after a hip fracture; 2) if the HMR strategy proves effective, to determine the mechanisms by which the HMR strategy is effective and to determine predictors of response to the HMR strategy; 3) to determine the level of adherence to the HMR strategy; and 4) to contrast the cost-effectiveness of the HMR strategy compared with UC and 5) if the HMR strategy proves cost-effective, to work toward incorporation of this strategy into the clinical care of hip fracture patients.
Specific aim 1 will be addressed in the Main Study.
Aims 2 -4 will be addressed through three sub-studies.
Aim 5 will be addressed in the Dissemination and Information Project.
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