Should we provide outreach rehabilitation to very old people living in nursing care facilities after a hip fracture? A randomised controlled trial

Maria Crotty, Maggie Killington, Enwu Liu, Ian Cameron, Susan Kurrle, Billingsley Kaambwa, Owen Davies, Michelle Miller, Mellick Chehade, Julie Ratcliffe

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Objective

to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care.

Design

parallel randomised controlled trial with integrated health economic study.

Setting

NCFs, in Adelaide South Australia.

Subjects

people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture.

Measurements

primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months.

Results

participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference −1.9; 95% CI: −3.3, −0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = −7.4; 95% CI: −12.5 to −2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: −0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056).

Conclusions

the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective.

Original languageEnglish
Pages (from-to)373-380
Number of pages8
JournalAge and Ageing
Volume48
Issue number3
Early online date22 Feb 2019
DOIs
Publication statusPublished - May 2019

Bibliographical note

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords

  • Aged care
  • Hip fracture
  • Mobility
  • Older people
  • Quality of life
  • Rehabilitation

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