Home Rehabilitation After Hip Fracture

Instituto de Investigacion Sanitaria La Fe80 enrolled

Overview

This study will examine whether a home-based rehabilitation program can help older adults recover after surgery for a hip fracture. The program is delivered by a specialized "Hospital-at-Home" unit, which provides hospital-level care in the patient's home. Participants in this study are adults aged 65 years and older who have undergone hip fracture surgery at Hospital Universitari i Politècnic La Fe in Valencia, Spain. Instead of remaining in the hospital after surgery, participants will be admitted to the Hospital-at-Home program. A multidisciplinary medical team will provide comprehensive care at home, including medication management, wound care, and in-home physical therapy. The primary goal of the study is to assess recovery of walking ability and mobility within the home. The study will also evaluate overall functional improvement, frailty, and survival. Participants will be assessed at the start of the program and again at 45 days and 180 days after surgery. The information collected will help determine whether this type of home-based care is an effective option for supporting recovery and independence in older adults after a hip fracture. Recruitment for the study began in February 2024 and is expected to continue for one year.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Hip Fractures (ICD-10 72.01-72.2)Home Care, Hospital-Based Home Care Services

Eligibility

Medical Language ↔ Plain English

Inclusion Criteria: * \- Patients aged 65 years or older undergoing surgery for traumatic hip fracture. * Ability to actively collaborate in the physiotherapy program. * Compliance with the UHD admission criteria (contact telephone number, identified caregiver, and residence within the geographical area of the Hospital Universitari i Politècnic La Fe). Exclusion Criteria: * \- Patients residing outside the geographical area covered by the La Fe hospital UHD. * Refusal to participate in the follow-up. * Clinical instability or end-of-life situation (oncologic or non-oncologic). * Cognitive impairment that prevents collaboration. * Institutionalized patients.

Outcomes

Primary Outcomes

Walking ability and home transfers

Walking ability and home transfers, taken from the Barthel Index

Time frame: assessed at different time points (prior, admission to the UHD, and at 45 and 180 days).

Secondary Outcomes

Functional improvement

measured by the change of the Barthel Index

Time frame: prior, admission to the UHD, and at 45 and 180 days

Mortality

Number of deaths

Time frame: 360 days

Frailty was assessed with the Rockwood Index at the time of admission, at baseline

The modified Clinical Frailty Scale (CFS) is a simple, 34-point clinical tool used by healthcare providers to quickly summarize a patient's overall level of fitness or frailty based on their mobility, energy, and function. It helps predict outcomes and guide care decisions in older adults.

Time frame: Baseline

Number of participants with all-cause readmission, delirium, wound infection, or bleeding

Safety was assessed by monitoring the occurrence of all-cause readmissions, episodes of delirium, wound infection, or bleeding during the intervention period.

Time frame: 15 days

Change in quality of life assessed by the EuroQoL-5D questionnaire

Quality of life was assessed using the EuroQol-5D-3L (EQ-5D-3L), a standardized instrument measuring health-related quality of life across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each with three levels. The descriptive system defines health states and does not itself yield a single score with fixed minimum and maximum values. Health states can be converted into a utility index typically ranging from values below 0 (worse than death) to 1 (full health), where higher scores indicate better health. Changes in quality of life will be assessed at 12 months

Time frame: One year