A number of studies for clinical pathway (CP) after hip fracture have been suggested to improve post-fracture outcome. However, CP is not carried out properly in most countries due to inadequate system and awareness, and lack of interdisciplinary approach among orthopaedists, geriatricians and rehabilitation specialists. Thus, we developed Fragility fracture integrated rehabilitation management (FIRM), a new standardized guideline and the multidisciplinary fragility fracture care based on the clinical rehabilitation pathway and conducted a prospective study to evaluate the effects of FIRM compared to conventional rehabilitation.
The purpose of this prospective study To develop a standardized fragility fracture integrated rehabilitation management (FIRM) based on the critical rehabilitation pathway for fragility fractures. 1. Standardization of initial evaluation for fall and re-fracture risks before rehabilitation 2. Standardization in initial screening for prevention for common complication after fracture and early diagnosis 3. Evidence based standardization in rehabilitation after fragility fracture 4. Development for safe return to normal daily life
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
288
FIRM program consisted of total 10 days session including PT, in two times twenty-minute sessions per day and 4 times OT during admission initiated before transfer to rehabilitation ward. PT (Weight bearing exercise, strengthening exercise, gait training, aerobic exercise and functional training) progressed gradually based on individual functional level and OT of activities of daily life (ADL) training (transfer, sit to stand, bed mobility, dressing, self-care retraining and using adaptive equipment) was provided.
Conventional rehabilitation program consisted of total 10 days session of PT focused on simple standing and gait training, in one time twenty-minute sessions per day.
Seoul National University Bundang Hospital
Seongnam-si, Gyeonggi-do, South Korea
RECRUITINGChange from baselines mobility status (Functional Ambulatory Category (FAC)) after rehabilitation
range, 0 to 5; decreasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines mobility status (KOVAL) after rehabilitation
range, 1 to 7; increasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines mobility status (Functional Independence Measure (FIM)- locomotion) after rehabilitation
range, 1 to 7; decreasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines balance and fall risk (Berg Balance Scale (BBS)) after rehabilitation
range, 0 to 56; decreasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines from cognition (Korean Mini-Mental State Examination (K-MMSE)) after rehabilitation
range, 0 to 30; decreasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines from mood (Korean version of the Geriatric Depression Scale (GDS)) after rehabilitation
range, 0 to 30 ; increasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines Quality of life (Euro Quality of Life Questionnaire 5-Dimensional Classification (EQ-5D)) after rehabilitation
range, 0 to 1; decreasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines from activities of daily life (Korean modified Barthel index (K-MBI)) after rehabilitation
range, 0 to 100; decreasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines from activities of daily life (Korean instrumental ADL (K-IADL)) after rehabilitation
range, 0 to 3; increasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines frailty (Korean version of fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale) after rehabilitation
range, 0 to 5; increasingly worse
Time frame: 0, 3 month, 6 month, 12 month
Change from baselines hand grip strength after rehabilitation
measured by a a digital dynamometer (TKK 5401 Grip-D; Takei, Niigata, Japan)
Time frame: 0, 3 month, 6 month, 12 month
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