Hip Fractures
Conditions
Brief summary
Approximately 30,000 adults in Quebec over the age of 50 suffer a fragility fracture each year. Fractures can affect a person's health, well-being and autonomy. Personal costs of these fractures are high, with as many as 50% of hip fracture patients being unable to return their pre-fracture level of autonomy. Homecare and community services provide customary rehabilitation support immediately following discharge from acute-care, though this contribution can be limited by lack of resources. For those patients at risk of negative outcomes, we have demonstrated clinically important benefits of extended exercise rehabilitation programs offered beyond the regular rehabilitation period on improving physical function. Through advances in sensor and telecommunication technology, eHealth solutions incorporated within homecare services as an integral part of the continuum of care can lead to better patient and health professional experience, improve clinical outcomes and reduce costs to the healthcare system. The purpose of this study is to determine if the implementation of a 3-month community-based extended-rehabilitation e-Monitoring and Coaching support program is more effective at improving mobility in community-dwelling elderly patients who have sustained a fracture than a printed material support program, and if these effects persist 6 months after discontinuation.
Interventions
DEVICEHIP Mobile e-Monitoring support
3-month community-based extended-rehabilitation e-Monitoring and Coaching support program
OTHERWorkbook support
Printed material support
Sponsors
Canadian Institutes of Health Research (CIHR)
Greybox Solutions Inc.
McGill University Health Centre/Research Institute of the McGill University Health Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Pragmatic randomized trial
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Community dwelling men and women aged ≥ 60 years * Treated for any fracture excluding hands, feet, patella, cervical spine, skull, ribs, or clavicle, at any of the 3 participating sites, within the previous 8 weeks.
Exclusion criteria
* Upper limb fractures that do not meet the criteria of gait frailty * Multiple traumas * Open fractures * Pathological fractures * Inability to communicate adequately in either French or English * Inability to give written informed consent * Discharge to a long-term care institution
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in mobility | 0, 1, 3, and 7 months | Measured as an ordinal mobility response variable quantified by the number of minimal clinically important changes (MIC) a participant attains using the gait speed and 30 second Sit to Stand tests. A person making no MIC in either measure is given a response category of 0, the lowest. A person changing by 1 MIC on only of the measures (either one) will be given a value of 1; a MIC gain on both measures would be assigned a value of 2, and so forth. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in walking endurance | 0, 1, 3, and 7 months | Measured using the 2-minute walk test. |
| Change in balance | 0, 1, 3, and 7 months | Measured using the Berg Balance Scale. |
| Change in the spatial area an individual moves through | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured using the Life Space Mobility Assessment |
| Change in global function status | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured using the Reintegration to Normal Living Index (RNLI) |
| Change in perceived physical health status | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by the physical function subscale of the RAND-36 |
| Change in grip strength | 0, 1, 3, and 7 months | Measured using a Jamar™ hand dynamometer. |
| Change in patient-reported health perception | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by the How Are You Today? Visual Analog Health States |
| Change in goal directed behavior | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by the Apathy Evaluation Scale |
| Change in global quality of life (QOL) | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by Patient Generated Index (PGI) |
| Change in cognition | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by the Perceived Deficits Questionnaire (PDQ) |
| Change in confidence in maintaining balance while doing daily activities. | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by the Activities-specific Balance Confidence Scale (ABC-S) |
| Change in Health-related quality of life | 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 months | Measured by the EQ-5D |
Countries
Canada
Outcome results
None listed