The long-term effect of being treated in a geriatric ward compared to an orthopaedic ward on six measures of free-living physical behavior 4 and 12 months after a hip fracture - a randomised controlled trial

Kristin Taraldsen, Pernille Thingstad, Olav Sletvold, Ingvild Saltvedt, Stian Lydersen, Malcolm H Granat, Sebastien Chastin, Jorunn L Helbostad, Kristin Taraldsen, Pernille Thingstad, Olav Sletvold, Ingvild Saltvedt, Stian Lydersen, Malcolm H Granat, Sebastien Chastin, Jorunn L Helbostad

Abstract

Background: This study is part of the Trondheim Hip Fracture Trial, where we compared free-living physical behavior in daily life 4 and 12 months following hip surgery for patients managed with comprehensive geriatric care (CGC) in a geriatric ward with those managed with orthopedic care (OC) in an orthopedic ward.

Methods: This is a single centre, prospective, randomized controlled trial. 397 hip fracture patients were randomized to CGC (n = 199) or OC (n = 198) in the Emergency Department with follow-up assessments performed four and 12 months post-surgery. Outcomes were mean upright time, number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor. Missing data were handled by multiple imputation and group differences assessed by linear regression with adjustments for gender, age and fracture type.

Results: There were no group differences in participants' pre-fracture characteristics. Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min (17.4 %, CI 9.6 to 59.6, p = .007) and at 12 months, 27.7 min (13.9 %, CI 3.5 to 51.8, p = .025). Average and maximum length of upright events was longer in the CGC (p's < .042). No group difference was found for number of upright events (p's > .452).

Conclusion: Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery, with more time and longer periods spent in upright. Results support findings from the same study for functional outcomes, and demonstrate that CGC impacts daily life as long as one year after surgery.

Trials registration: ClinicalTrials.gov, NCT00667914 , April 18, 2008.

Figures

Fig. 1
Fig. 1
Flow diagram activity monitoring in the Trondheim Hip Fracture Trial. Note: The figure shows number of completers at 4 and 12 months. Reasons for drop outs are listed separate for 4 and 12 months, where the total number of drop outs at 12 months lists all drop outs during the 12 months follow-up
Fig. 2
Fig. 2
Upright time over 24 h 4 months (upper) and 12 months (lower) postsurgery, showing the mean time in upright for each hour of the day for comprehensive geriatric care (CGC) and orthopedic care (OC)

References

    1. Fiatarone Singh MA, Singh NA, Hansen RD, Finnegan TP, Allen BJ, Diamond TH, et al. Methodology and baseline characteristics for the Sarcopenia and Hip Fracture study: a 5-year prospective study. J Gerontol A Biol Sci Med Sci. 2009;64(5):568–574. doi: 10.1093/gerona/glp002.
    1. Mak JC, Cameron ID, March LM, National H. Medical Research C Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust. 2010;192(1):37–41.
    1. Culhane KM, O'Connor M, Lyons D, Lyons GM. Accelerometers in rehabilitation medicine for older adults. Age Ageing. 2005;34(6):556–560. doi: 10.1093/ageing/afi192.
    1. Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170(10):1290–1299. doi: 10.1093/aje/kwp266.
    1. Resnick B, Galik E, Boltz M, Hawkes W, Shardell M, Orwig D, et al. Physical activity in the post-hip-fracture period. J Aging Phys Act. 2011;19(4):373–387.
    1. Gill TM, Allore H, Guo Z. The deleterious effects of bed rest among community-living older persons. J Gerontol A Biol Sci Med Sci. 2004;59(7):755–761. doi: 10.1093/gerona/59.7.M755.
    1. Gill TM, Allore HG, Holford TR, Guo Z. Hospitalization, restricted activity, and the development of disability among older persons. JAMA. 2004;292(17):2115–2124. doi: 10.1001/jama.292.17.2115.
    1. Taraldsen K, Sletvold O, Thingstad P, Saltvedt I, Granat MH, Lydersen S et al. Physical Behavior and Function Early After Hip Fracture Surgery in Patients Receiving Comprehensive Geriatric Care or Orthopedic Care--A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci. 2013. doi:10.1093/gerona/glt097.
    1. Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Prestmo A, Lamb SE, et al. Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture trial. BMC Geriatr. 2011;11:18. doi: 10.1186/1471-2318-11-18.
    1. Prestmo A, Hagen G, Sletvold O, Helbostad J, Thingstad P, Taraldsen K et al. Comprehensive geriatric care for patients with hip-fractures: a prospective, randomised, controlled trial. Lancet. 2015;25;385(9978):1623–33. doi: 10.1016/S0140-6736(14)62409-0.
    1. Saltvedt I, Prestmo A, Einarsen E, Johnsen LG, Helbostad JL, Sletvold O. Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture. BMC Research Notes. 2012;5(1):355. doi: 10.1186/1756-0500-5-355.
    1. Gladman JR, Lincoln NB, Adams SA. Use of the extended ADL scale with stroke patients. Age Ageing. 1993;22(6):419–424. doi: 10.1093/ageing/22.6.419.
    1. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–65.
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94. doi: 10.1093/geronj/49.2.M85.
    1. Taraldsen K, Askim T, Sletvold O, Einarsen EK, Gruner Bjastad K, Indredavik B, et al. Evaluation of a body-worn sensor system to measure physical activity in older people with impaired function. Phys Ther. 2011;91(2):277–285. doi: 10.2522/ptj.20100159.
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30(4):377–399. doi: 10.1002/sim.4067.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–762. doi: 10.1016/S0140-6736(12)62167-9.
    1. Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011;7:CD006211.
    1. Grant PM, Granat MH, Thow MK, Maclaren WM. Analyzing free-living physical activity of older adults in different environments using body-worn activity monitors. J Aging Phys Act. 2010;18(2):171–184.
    1. Vissers MM, Bussmann JB, de Groot IB, Verhaar JA, Reijman M. Physical functioning four years after total hip and knee arthroplasty. Gait Posture. 2013;38(2):310–315. doi: 10.1016/j.gaitpost.2012.12.007.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit