The steady increase in the incidence of geriatric hip fracture places an increasing burden on health care service in Hong Kong. Post fracture limitations are prominent and restrain many of the elderly from returning to community, rehabilitation is therefore important for reducing their long-term disability. By integrating the results from pilot application of video guided training and tele-physiotherapy program in different phases of rehabilitation, a Mobile Application (app) is developed aiming to improve hip fracture patients' and their carers' experience throughout the healthcare journey and empower them to manage their own health. A steering group comprised of physiotherapists, informatics and university research expert is formed to co-design the app, compose education content and formulate the promulgation and evaluation strategies. Meetings are also held with all involved clinicians to refine the app before implementation. This app provides features for hip fracture rehabilitation including "Understanding Hip Fracture", "Hip Fracture Care", "Training" and "Companion". Patients and their carers can obtain hip fracture care related information through the app anywhere, anytime, instead of coming to the clinics in person or reading the information on pamphlets. Physiotherapists can use the app to set training program for discharged patients with "Push Reminder" function and training record can be saved in "Progress Summary", which facilitates them and carers to get a grip on the patients' rehabilitation progress. Clinical study is therefore planned to be conducted to evaluate the effectiveness of the app from different perspectives, including the users' acceptance and satisfaction, patients' program compliance and functional recovery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
144
Home-based rehabilitation program
Tai Po Hospital
Hong Kong, Hong Kong
RECRUITINGLower extremity functional scale
LEFS is a 20-item questionnaire intended to measure patients' functions with a wide range of lower extremity conditions. Each item is rated on a five-point scale (0 - extreme difficulty or unable to perform activity, 4 - no difficulty); total scores range from 0 to 80, and lower scores represent greater difficulty. It has been shown to be highly reliable, correlates with other constructs, and is an independent predictor of patient and physician assessment of change in patients. The minimal clinically important difference (MCID) for the LEFS is 9 points.
Time frame: 2 months
Elderly Mobility Scale
The Elderly Mobility scale (EMS) is used to assess an individual's mobility problems through seven functional activities including lying, siting, standing and walking. The possible total score is 20. Patients that get a score under 10 indicate they are dependent in mobility. They require other people to assist their basic activities of daily living (ADL). Patients that get a score between 10 and 13 indicate they are marginal in terms of safe mobility however independent in ADL to a certain extent. Patients that get a score over 14 indicate they are able to perform mobility independently and safely. They are independent in basic ADL. EMS has been demonstrated a good inter-rater reliability and concurrent validity.
Time frame: 2 months
Modified Functional Ambulatory Category
The MFAC is a 7-point Likert Scale (1 -7) that is used to classify a patient's walking capacity. Gait is divided into seven categories, ranging from no ability to walk and requires manual assistance to sit or is unable to sit for 1 minute without back or hand support (MFAC 1) to the ability to walk independently on level and non-level surfaces, stairs, and inclines (MFAC 7). The inter-rater reliability of the MFAC (intraclass coefficient \[ICC\]) was 0.982 (0.971-0.989), with a kappa coefficient of 0.923 and a consistency ratio of 94% for stroke patient and the ICC of the MFAC in patients with hip fractures is 0.96, with a construct validity of r=0.81 on the Elderly Mobility Scale (EMS).
Time frame: 2 months
Time Up and Go Test
A test that assesses mobility, balance, walking ability, and fall risk in older adults
Time frame: 2 months
Self-reported exercise adherence
Participants will be asked to rate their adherence to their home program using 11-point numerical rating scale (0='never performed my exercises' to 10 = 'always performed my exercises'. This method of capturing adherence is selected because there are few alternative ways of determining adherence that does not involve full-time surveillance.
Time frame: 2 months
Exercise logs
Participants will be asked to report their exercise log either by the use of Progress summary function of the app in experimental group or by exercise diaries set out in calendar format prepared in the exercise pamphlet in control group
Time frame: 2 months
Modified Caregiver Strain Index
It was designed to detect the physical, psychological, social and financial strain of the informal caregiver. It consisted of 13-items. There were only 3 options (score 2 if the respondent choose "yes", 1 if the respondent choose "yes, sometimes", otherwise score 0 if the respondent choose "no") for the respondent to choose. The CSI score ranged from 0 to 26. Caregivers face a high level of strain if they score high. The modified version of CSI (M-CSI) achieved a high internal reliabilty (α=.90).
Time frame: 2 months
System Usability Scale
It is a quick survey to assess the usability of a given product or service. The survey consist ten questions with five possible answers ranging from 'strongly agree' to 'strongly disagree'. Scoring SUS * For each of the odd numbered questions, subtract 1 from the score. * For each of the even numbered questions, subtract their value from 5. * Take these new values which you have found, and add up the total score. Then multiply this by 2.5. Interpreting Scores The participant's scores for each question are converted to a new number, added together and then multiplied by 2.5 to convert the original scores of 0-40 to 0-100. Though the scores are 0-100, these are not percentages and should be considered only in terms of their percentile ranking. Based on research, a SUS score above a 68 would be considered above average and anything below 68 is below average, however the best way to interpret your results involves "normalizing" the scores to produce a percentile ranking.
Time frame: 2 months
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