Hip fracture is one of the leading healthcare problems requiring rehabilitation services in older Americans. Three models of rehabilitation treatment are available for patients recovering from hip fracture that include acute inpatient rehabilitation (AR), nursing home rehabilitation (NHR) and home care rehabilitation (HCR). These settings differ based on the timing, duration and intensity of services provided. No prior randomized study has been performed to determine the optimum rehabilitation treatment to improve the rate of functional recovery and return home to the community for patients with hip fracture. This planning grant will complete work in the following key domains during the two-year grant cycle to perform a randomized controlled trial (1) coordinating facilities to assist subject recruitment using state of the art bioinformatics systems within the University of Pittsburgh Medical Center Health System; (2) performing focus interviews to better understand patient, family, physician and therapist values concerning the randomization process; (3) determining the best method to risk stratify patients to different treatment settings that include random assignment to a home rehabilitation arm; (4) refining physical and occupational therapy algorithms using similar treatment goals at each location; (5) incorporating outcomes that are validated, objective and reliable measures of self-reported function and observed physical performance; and (6) standardizing data measurements in all rehabilitation environments through the implementation of quality control procedures. Co-investigators from the RAND Corporation will refine methods for data analysis using their extensive expertise in outcome assessment. At the end of this two-year planning grant, the investigators expect to be well positioned to perform a randomized controlled trial. Primary hypotheses will test whether AR subjects have higher function and a lower percentage of extended care facility placements than patients receiving NHR or HCR. Using novel methodology developed by the research team, secondary hypotheses will evaluate the relationship of functional outcomes and intensity of therapy to level of participation in therapy and physical activity measured by an activity monitor.
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