The goal of this observational study is to learn about and monitor the cross-sectoral rehabilitation process in older high-risk patients treated for at fragility fracture of the hip. The main questions aim to answer: * how patients are doing up to one year after hip fracture surgery on different outcomes across the continuum of rehabilitation being offered * what expectations, experiences and satisfaction patients have for the overall rehabilitation process after a hip fracture Participants age 65 and above with home address in Frederiksberg municipality, living in own home, admitted and treated for at hip fracture at Department of Orthopedic Surgery, Bispebjerg Hospital, will be asked for participation.
In addition to primary and secondary outcome measures some of the patients will be asked to respond to a interviewer-based questionnaire, about their experiences of the rehabilitation offered during their hospital stay and at the temporary municipality-based 24-hour setting / or at home during the first couple of months. Furthermore, they will be interviewed about their expectations for rehabilitation in the municipality at time of discharge from the acute hospital.
Study Type
OBSERVATIONAL
Enrollment
53
Department of Physio- and Occupational Therapy and Othopedic Surgery, University Hospital Bispebjerg and Frederiksberg
Copenhagen, Denmark
Recovery of pre-fracture function
Recovery of function related to the pre-fracture level (re-call last week before fracture) will be assessed with New mobility Score (score 0-9) pre-fracture, at start and end of rehabilitation in municipality, 3-4 month and 1 year post-fracture
Time frame: Recovery of pre-fracture function at 3-4 months post-fracture as primary outcome
Basic mobility
Will be measured using Cumulated Ambulation Score (CAS). It describes the patients' independence in three activities (getting in and out of bed, sit-to-stand from a chair, and walking), with each activity assessed on a three-point ordinal scale from 0 to 2, resulting in a total CAS between 0 and 6 (6 is maximum score indicating the patient to be independent in basic mobility).
Time frame: Pre-fracture, at inclusion and discharge from hospital, at start and end of rehabilitation in municipality, 3-4 months and 1 year post-fracture
30 second chair stand test (CST)
CST test measures how many times a person can stand up from a chair in 30 seconds, without using their arms.
Time frame: At inclusion and discharge from hospital, at start and end of rehabilitation in municipality and 3-4 months post-fracture
Timed Up & Go test (TUG)
TUG test measures the time in seconds it takes a person to stand up from a regular chair with back and armrests, walk 3 meters, turn around, go back to the chair and sit down again
Time frame: At start and end of rehabilitation in municipality and 3-4 months post-fracture
Hip related pain
Will be assessed using the 5-point Verbal Rating Scale (VRS, no pain, slight pain, moderate pain, severe pain, and unbearable pain) during weight-bearing activities
Time frame: At inclusion and discharge from hospital, at start and end of rehabilitation in municipality, 3-4 months and 1 year post-fracture
Hand Grip Strength (HGS)
HGS measures how much strength a person has in their dominant hand. If the dominant hand is injured (e.g. by paralysis or fracture), the test is carried out with the non-dominant hand. Although the measure of HGS assesses the function of one muscle group, it is regarded as an indicator of overall body strength.
Time frame: At inclusion at the hospital, at start and end of rehabilitation in municipality and 3-4 months post-fracture
Health questionnaire
Will be assessed by the EQ-5D-5L questionnaire. The questionnaire comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems.
Time frame: At pre-fracture (recall) and 3-4 months and 1-year post-fracture
Physical activity (weekly)
Will be assessed using a validated questionnaire from the Swedish National Board of Health and Welfare, providing a total score from 3 to 19. A score ≥11 corresponds to fulfillment of the Word Health Organization's recommendation for weekly physical activity
Time frame: At inclusion (recall of the last few weeks before present hospitalization) and 1-year post-fracture
Physical activity / upright time (time standing and walking)
Will be measured using SENS Innovation Aps motion activity measurement system which is a waterproof activity sensor placed laterally on the opposite thigh of the fractured hip.
Time frame: From inclusion until 9 days post-discharge
Frailty
Will be assessed using Clinical Frailty Scale (CFS) which is a clinical judgement-based frailty tool. The CFS evaluates specific domains including comorbidity, function., and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill).
Time frame: At pre-fracture (recall) and 1-year post-fracture
Fear of falling
Will be assessed with Short-Falls Efficacy Scale, minimum 7 (no concern about falling) to maximum 28 (severe concern about falling). Assesses fear of falling conceptualized as concerns about falling in an 7 item questionnaire.
Time frame: At discharge and 3-4 months and 1-year post-fracture
Comorbidity
Will be assessed using The American Society of Anesthesiologists (ASA) physical status classification system. The ASA score is a subjective assessment of a patient's overall health that is based on five classes. One means the patients is healthy and fit, and 5 is a moribund patient who is not expected to live 24 hour with or without surgery.
Time frame: At inclusion
Cognitive status
Will be assessed using the Short Orientation-Memory Concentration (OMC). It consists of a 6-item patient reported questionnaire and is validated as a measure of cognitive impairment. The score ranges from 0-28 where 0 is equal to normal cognition and 28 is appraised as a severe impairment.
Time frame: At inclusion
Number of falls
Place and cause
Time frame: At start and end of rehabilitation in municipality, 3-4 months and 1 year post-fracture
Residential status / discharge destination
Residential status pre-fracture and discharge destination
Time frame: At discharge from hospital and 24-hour rehabilitation setting
Length of stay in acute hospital
Number of days
Time frame: From surgery till discharge
Number of weekly exercise sessions with therapist in all settings
The number of weekly exercise sessions with therapist at hospital, and in the municipality
Time frame: At discharge and end of rehabilitation in municipality
Number of rehab weeks
In the municipality
Time frame: At end of rehabilitation in municipality
Type of training in Municipality
Type of rehabilitation with a physiotherapist in Frederiksberg Municipality, at home or individual or team training in the centre, or a mixture of both
Time frame: At end of rehabilitation in the Municipality
Training after discharge from 24-hour setting
If the patient has been on a 24-hour setting, is training then continued after discharge
Time frame: At discharge from 24-hour setting
Home care, nurse/other health assistance, times pr week
Assistance with personal care, preparing dinner, grocery shopping, cleaning etc
Time frame: At pre-fracture, at start and end of rehabilitation in municipality and 3-4 months and 1-year post-fracture
Data 30 days post-discharge
The patient record will be reviewed and it will be recorded if the patient has been readmitted or has died.
Time frame: 30 day post-discharge
Data 3 months post-discharge
The patient record will be reviewed and it will be recorded if the patient has been readmitted or has died.
Time frame: 3 month post-discharge
Data 1 year post-discharge
The patient record will be reviewed and it will be recorded if the patient has undergone reoperation or has died.
Time frame: 1 year post-discharge
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