Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial

Journal article


Crotty, Maria, Killington, Maggie, Liu, Enwu, Cameron, Ian D., Kurrle, Susan, Kaambwa, Billingsley, Davies, Owen, Miller, Michelle D., Chehade, Mellick and Ratcliffe, Julie. (2019) Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial. Age and Ageing. 48(3), pp. 373 - 380. https://doi.org/10.1093/ageing/afz005
AuthorsCrotty, Maria, Killington, Maggie, Liu, Enwu, Cameron, Ian D., Kurrle, Susan, Kaambwa, Billingsley, Davies, Owen, Miller, Michelle D., Chehade, Mellick and Ratcliffe, Julie
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. Trial registration ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 361980

Keywordship fracture; rehabilitation; aged care; mobility; quality of life; older people
Year2019
JournalAge and Ageing
Journal citation48 (3), pp. 373 - 380
PublisherOxford University Press
ISSN0002-0729
Digital Object Identifier (DOI)https://doi.org/10.1093/ageing/afz005
Scopus EID2-s2.0-85065775047
Open accessOpen access
Page range373 - 380
Research GroupMary MacKillop Institute for Health Research
Publisher's version
License
Place of publicationUnited Kingdom
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