High Intensity Physiotherapy for Hip Fractures (HIP4hips)

High Intensity Physiotherapy for Hip Fractures in the Acute Hospital Setting

Every day, more than 40 Australian break their hip, Most are over the age of sixty five. Hip fractures are a significant problem for the older people, the hospital system and community as a whole because of the increasing numbers of fractures and the cost of hospitalisation and ongoing care. After one year, less than half of all people with a hip fracture can walk as well as they did before the fracture. Physiotherapy in the acute hospital setting is an integral part of patient care, although the intensity of physiotherapy a patient receives is variable and the optimal number of treatment sessions per day remains unknown. Studies in other patient groups have shown that increased physiotherapy can improve patient outcomes by increasing muscle strength and mobility. It can also reduce the negative effects of bed rest such as muscle wasting, blood clots in the lungs or leg veins and chest infections such as pneumonia. This study aims to investigate the effectiveness of an intensive physiotherapy program in hip fracture patients to further understand this and the effect it has on patient function.

In this research the investigators will randomly allocate patients into 2 groups; usual care and intensive physiotherapy. The usual care group will have physiotherapy treatment daily whereas the intensive physiotherapy group will have an additional daily treatment by a physiotherapist as well as a daily treatment by an allied health assistant. The objectives are to achieve better functional outcomes in the patient's hospital stay (ie improved mobility), reduce the time for patients to be physically ready to go home, increase the number of patients able to go directly home or to fast stream rehabilitation (rather than a slow stream option).

If increased intensity of physiotherapy is found to improve patient's mobility outcomes, this research will provide the confidence to endorse a change to current clinical practice.

Study Overview

• Status: Completed
• Conditions: Hip Fractures
• Intervention / Treatment: Other: Usual Care; Other: Intensive physiotherapy

• Study Type: Interventional
• Enrollment (Actual): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Australia
  • Victoria
    • Melbourne, Victoria, Australia, 3181
      • The Alfred

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Admission to The Alfred with an isolated hip fracture and treated with internal fixation, aged 65 or above

Exclusion Criteria:

• fracture is in the sub-trochanteric region of the femur,
• if it is pathological,
• if post operative orders are for non-weight bearing on the operated hip,
• if they were unable to mobilise independently (or with gait aid) prior to admission,
• or if they were admitted from a nursing home.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Usual care; usual care physiotherapy - once daily treatment whilst inpatient in acute hospital	Other: Usual Care; once daily physiotherapy whilst acute hospital inpatient
Experimental: Intensive physiotherapy; additional once daily physiotherapy and once daily allied health assistant intervention	Other: Intensive physiotherapy; additional once daily physiotherapy and once daily allied health assistant intervention (equals two more treatments) whilst an inpatient in acute hospital

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
modified IOWA Level of Assistance Scale	Functional score measuring 6 mobility domains	5 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
length of stay - acute and rehabilitation	the length of acute hospital stay and rehabilitation stay - until discharge home or to a long term facility	participants will be followed for duration of hospital stay - average one month
timed up and go		5 days
Glasgow Outcomes Score -Extended		6 months
discharge destination	discharge destination from the acute hospital - options include: home, fast stream rehabilitation, slow stream rehabilitation, long term facility	participants will be followed until discharge from the acute hospital - average 10 days
physical readiness for discharge	when a patient is deemed physically ready go home - eg can access their house and mobilise within house and outdoors	average one month
12-Item Short Form Health Survey (SF-12)		6 months
EuroQOL five dimensions questionnaire (EQ-5D)		6 months

Collaborators and Investigators

• Sponsor: The Alfred
• Investigators: Principal Investigator: Lara A Kimmel, B.Physio, The Alfred

Publications and helpful links

General Publications

• Kimmel LA, Liew SM, Sayer JM, Holland AE. HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial. Med J Aust. 2016 Jul 18;205(2):73-8. doi: 10.5694/mja16.00091.

Study record dates

Study Major Dates

• Study Start: March 1, 2014
• Primary Completion (Actual): January 1, 2015
• Study Completion (Actual): September 1, 2015

Study Registration Dates

• First Submitted: March 6, 2014
• First Submitted That Met QC Criteria: March 14, 2014
• First Posted (Estimate): March 17, 2014

Study Record Updates

• Last Update Posted (Estimate): December 31, 2015
• Last Update Submitted That Met QC Criteria: December 29, 2015
• Last Verified: December 1, 2015

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: 32/14