Post-discharge management following hip fracture--get you back to B4: a parallel group, randomized controlled trial study protocol

Wendy L Cook, Karim M Khan, Michelle H Bech, Penelope M Brasher, Roy A Brown, Stirling Bryan, Meghan G Donaldson, Pierre Guy, Heather M Hanson, Cheryl Leia, Erin M Macri, Joanie Sims-Gould, Heather A McKay, Maureen C Ashe, Wendy L Cook, Karim M Khan, Michelle H Bech, Penelope M Brasher, Roy A Brown, Stirling Bryan, Meghan G Donaldson, Pierre Guy, Heather M Hanson, Cheryl Leia, Erin M Macri, Joanie Sims-Gould, Heather A McKay, Maureen C Ashe

Abstract

Background: Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes.

Methods/design: This is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture. We will enrol 130 older adults (65 years+) who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service. Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility, operationalized as the Short Physical Performance Battery at 12 months. Secondary outcomes include frailty, rehospitalizations, falls risk factors, quality of life, as well as physical activity and sedentary behaviour. We will conduct an economic evaluation to determine health related costs in the first year, and a process evaluation to ascertain the acceptance of the program by older adults, as well as clinicians and staff within the clinic.

Trial registration number: ClinicalTrials.gov: NCT01254942.

Figures

Figure 1
Figure 1
Flow diagram of the phases of the B4 Clinic trial.

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