Abstract
Introduction/Background
It is unclear whether team based rehabilitation will improve survival or recovery in people from nursing care facilities (NCFs) who frequently have dementia and substantial disability. The objective was to determine whether post-operative rehabilitation delivered in NCFs would improve quality of life and mobility compared to receiving usual care and to perform an economic evaluation of this intervention.
Material and method
Randomised controlled trial in NCFs, in Adelaide South Australia. Participants were people aged 70 years and older who were recovering from hip fracture surgery and were walking (independently, with aids or with one person assistance) prior to hip fracture. They received either a 4-week rehabilitation program delivered by hospital outreach team, or usual care. Those assessing the outcomes were blinded to group assignment. The primary outcomes were mobility [Nursing Home Life-Space Diameter (NHLSD)] and quality of life (DEMQOL) at one month (30 days) and 12 months. The incremental costs per unit improvement in mobility (NHLSD) and the incremental costs per quality adjusted life year (QALY) gained were calculated.
Results
At one month, the treatment group had better mobility (NHLSD) (mean difference −2.4; 95% CI: −3.8, −0.9; P = 0.0014), better quality of life (DEMQOL: mean difference −0.14; 95% CI: −0.26, −0.01; P = 0.0363 and DEMQOL-Proxy: −0.09; 95% CI: − 0.17, −0.02; P = 0.017) and were more likely to be alive (log rank test P = 0.048). At 12 months there were no differences between treatment and control groups.
Conclusion
The survival and functional benefits did not persist once the rehabilitation program ended. The case for funding home rehabilitation in NCFs is weak from a traditional health economic perspective.
It is unclear whether team based rehabilitation will improve survival or recovery in people from nursing care facilities (NCFs) who frequently have dementia and substantial disability. The objective was to determine whether post-operative rehabilitation delivered in NCFs would improve quality of life and mobility compared to receiving usual care and to perform an economic evaluation of this intervention.
Material and method
Randomised controlled trial in NCFs, in Adelaide South Australia. Participants were people aged 70 years and older who were recovering from hip fracture surgery and were walking (independently, with aids or with one person assistance) prior to hip fracture. They received either a 4-week rehabilitation program delivered by hospital outreach team, or usual care. Those assessing the outcomes were blinded to group assignment. The primary outcomes were mobility [Nursing Home Life-Space Diameter (NHLSD)] and quality of life (DEMQOL) at one month (30 days) and 12 months. The incremental costs per unit improvement in mobility (NHLSD) and the incremental costs per quality adjusted life year (QALY) gained were calculated.
Results
At one month, the treatment group had better mobility (NHLSD) (mean difference −2.4; 95% CI: −3.8, −0.9; P = 0.0014), better quality of life (DEMQOL: mean difference −0.14; 95% CI: −0.26, −0.01; P = 0.0363 and DEMQOL-Proxy: −0.09; 95% CI: − 0.17, −0.02; P = 0.017) and were more likely to be alive (log rank test P = 0.048). At 12 months there were no differences between treatment and control groups.
Conclusion
The survival and functional benefits did not persist once the rehabilitation program ended. The case for funding home rehabilitation in NCFs is weak from a traditional health economic perspective.
| Original language | English |
|---|---|
| Article number | ISPR8-2121 |
| Pages (from-to) | e339 |
| Number of pages | 1 |
| Journal | Annals of Physical and Rehabilitation Medicine |
| Volume | 61 |
| Issue number | supplement |
| DOIs | |
| Publication status | Published - Jul 2018 |
Keywords
- Hip fracture
- Rehabilitation
- Aged care
- Nursing homes
- Randomised trial
