None listed
Conditions
Brief summary
This randomised controlled trial will investigate the feasibility of an allied health assistant providing physiotherapy to people following hip fracture surgery. The allied health assistant will provide all therapy to people in hospital. All therapy will be prescribed by a physiotherapist and will include daily walking, and standing and seated exercises. We hypothesise that it is feasible for allied health assistants to provide physiotherapy to people after hip fracture surgery.
Interventions
Name of intervention: Allied health assistant provision of routine post-operative hip fracture rehabilitation
Who will deliver the intervention and what is their training: The intervention will be delivered by a senior allied health assistant (grade 3). The allied health assistant will have a certificate IV allied health assistant qualification. A senior (grade 3) acute orthopaedic physiotherapist will supervise the senior allied health assistant as per health network clinical supervision guide
Name of intervention: Allied health assistant provision of routine post-operative hip fracture rehabilitation Who will deliver the intervention and what is their training: The intervention will be delivered by a senior allied health assistant (grade 3). The allied health assistant will have a certificate IV allied health assistant qualification. A senior (grade 3) acute orthopaedic physiotherapist will supervise the senior allied health assistant as per health network clinical supervision guidelines. This supervision will include monthly meetings to discuss professional and clinical skill development in the management of people recovering from hip fracture. It will also involve direct supervision/observation of the senior allied health assistant’s management of people recovering from hip fracture. Mode of delivery: Individual, face-to-face Dose: Daily therapy provided on weekdays (i.e. daily therapy 5x per week) until discharge from acute hospital. Initial physiotherapy assessment may occur on a Saturday if hip fracture surgery performed on a Friday. The duration of each session will vary dependent on patient needs. Location/Timing: All therapy will be provided to patients recovering from hip fracture surgery on the orthopaedic ward at Frankston Hospital. Therapy will be provided by the allied health assistant following an initial post-operative physiotherapy assessment of the patient. The allied health assistant will be delegated provision of routine post-operative hip fracture rehabilitation if the patient is transferred to sitting out of bed during the physiotherapy assessment and appropriate for mobilisation (walking). This process will involve the physiotherapist completing an initial assessment and providing a thorough handover to the allied health assistant. Procedures and personalisation: Routine acute rehabilitation of patients with hip fracture should include daily mobilisation (i.e. walking) as per Australian and New Zealand Hip Fracture Registry Guidelines and may also include: 1) progression of gait aid 2) standing/seated exercises (e.g. squats, sit-to-stand, calf raises) 3) education (e.g. falls risk strategies) All therapy will be prescribed by the physiotherapist who conducts the initial assessment and tailored to the individual needs of the patient and the therapy will be implementd by the allied health assistant. As per standard protocol, following treatment of the patient with hip fracture the allied health assistant will inform the physiotherapist, who completed the initial assessment, of the details of the session and the patient’s progress in their ability to mobilise. The physiotherapist will use this feedback to determine the discharge plan and re-assess the patient as required. Fidelity: The fidelity of the intervention will be determined by measuring the time and occasions of service each patient spends with i) the physiotherapist and ii) the allied health assistant.
Sponsors
Peninsula Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient participants Eligible participants will be patients who have undergone surgery for management of hip fracture at the participating acute hospital site. Participants must meet the following eligibility criteria: • Inpatient at acute hospital participating site • Admission diagnosis of hip fracture (S72.0–S72.2 according to the International Classification of Diseases 10th revision (ICD-10) • Walked independently pre-hip fracture with or without the use of a walking aid • Willingness and ability (i.e. medically stable), as determined by initial physiotherapy assessment, to participate in post-operative physiotherapy • Aged 18 years or older • Able to provide written, informed consent • Able to communicate in conversational English Staff participants: Staff participants for this project include any allied health assistant, physiotherapist or manager involved in the implementation of the allied health assistant model of care. They will include the following staff who either i) work on the orthopaedic ward at the acute hospital participating site or ii) have managerial oversight of physiotherapists working on the orthopaedic ward.
Exclusion criteria
Patient Participants: Exclusion criteria are: • Patients unable to participate in physiotherapy rehabilitation (e.g. patients with a post-operative lower extremity touch or non-weight bearing status) • Patients who were non-ambulant OR required assistance of another person to walk pre-hip fracture • Patient not suitable for mobilisation or physiotherapy • Impaired cognition (Short Portable Mental Status Questionnaire Score <8) If the patient is not appropriate for mobilisation they will not be eligible for participation in the study. However, participants are eligible for inclusion in the study if their medical stability improves on any day during their admission. Mobilisation will be contraindicated if the patient experiences any of the following complications: • Severe post-operative pain that restricts weight bearing • Nausea or vomiting with or without antimetic • Vitally unstable: postural blood pressure drop, febrile, bradycardia <40bpm or abnormal heart rhythm • Disorientated, heavily sedated or difficult to rouse. Staff Participants: Staff who are not involved in the implementation of the allied health assistant model of care will not be eligible for inclusion.
Outcome results
None listed