Title: HIP HELPER - Improving patient recovery following hip fracture through caregiver support: a feasibility study
Funder: Department of Health and Social Care

Abstract: RESEARCH QUESTION: What is the feasibility of a randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture. BACKGROUND: Approximately 80,000 people aged 60 years and over experience a hip fracture in the UK annually[1,2]. Nearly 60% do not return to their pre-injury level of function by 6 months[3], with 20% dying during the first year[4]. Provision of rehabilitation across the UK is poor, with wide variation in its extent, quality and duration[5]. Family members and friends, as informal caregivers, are expected to support patients on leaving hospital, to facilitate on-going recovery[6]. However caregivers frequently feel under-skilled, with low confidence to help[6,7]. Teaching caregiver skills to better support patients following hip fracture may improve quality of life and independence and reduce burden for patients and caregivers[8,9]. This study begins to address this by testing a caregiver intervention for this population. AIMS: To assess the feasibility of a RCT to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture. OBJECTIVES: To evaluate: 1. Feasibility of recruitment (patients and caregivers). 2. Acceptability of the intervention. 3. Fidelity of health professionals to deliver the intervention. 4. Fidelity of caregivers to deliver the intervention at home. 5. Acceptability of randomisation. 6. Risk of intervention contamination. 7. Completeness of data collection. METHODS: Setting: 4 acute NHS hospitals. Population: 60 community-dwelling patients, with and without cognitive impairment, who undergo surgery following hip fracture, and who have an informal caregiver. Experimental Intervention: Standard NHS care PLUS three, 1-hour, one-to-one training sessions, delivered by a nurse, physiotherapist or occupational therapist in an in-patient hospital setting and 3 telephone call interventions post-discharge. Training in the hospital consists of practical skills taught to caregivers on transfers and walking; education to patients and caregivers on recovery goal-setting and expectations, pacing and stress management techniques for caregivers and patients and the provision of the HIP HELPER Workbook, providing information on recovery, worksheets, goal-setting plans and checklists to guide caregivers and patients on a good recovery and how to facilitate this. Control: Standard NHS care consisting of routine post-operative physiotherapy, occupational therapy and nursing care. Measurement: Data, collected at baseline and 4 months post-randomisation, will include: screening logs, intervention logs, fidelity checklists, delegation logs, quality assurance monitoring visit data and clinical outcomes including quality of life, physical, emotional, adverse event and resource use outcomes. Qualitative Study: We will interview 20 participants (patients and informal caregivers) and 12 health professionals to investigate their perceptions of the intervention and study. TIMELINES: Prior to start: Protocol and approvals Month 1-2: Finalise approvals. Site set-up Month 2-14: Recruitment Month 2-18: Data collection Month 18-20: Analysis Month 19-22: Publication/protocol preparation for definitive trial ANTICIPATED IMPACT/DISSEMINATION: The results will provide critical information for the design of a definitive NIHR-funded RCT. With our PPI representatives and wider stakeholders, we have developed a broad dissemination strategy including production of papers, briefing reports and media content.

Lay abstract: BACKGROUND: A broken hip (hip fracture) is a common injury in older people. Not all people recover well, with most people less mobile and less independent afterwards. Family members or friends often take on roles as caregivers, helping in tasks such as washing, dressing, cooking and shopping, once their relative or friend is home from hospital. Unfortunately caregivers are often under-prepared to do this. They are left to work out what to do themselves, and often ask the patient to do less than they could do for fear of causing harm. This can create stress for patients and caregivers and may mean that patients do not recover as well as or as quickly as possible. A training programme to guide caregivers on what to do before patients are discharged home could solve many of these problems and improve outcomes. AIM: To conduct a feasibility study to see if a caregiver training programme, designed by health professionals and patients, can be provided in an NHS setting following hip fracture surgery, and how a future trial may be designed. DESIGN AND METHODS: This feasibility study comprises of a small trial and qualitative (interview) study. We will test this training programme and project design in a small way to see if it works, and if not, what needs to change. We will recruit 60 patients and their caregivers (120 people). Half will receive the new training programme PLUS standard NHS care, the other half will only receive standard NHS care. The training programme is 3, 1-hour face-to-face sessions where a nurse, physiotherapist or occupational therapist will talk about the patient s expected recovery plan, will show the caregiver how to help the patient get out of bed or a chair and how to use walking aids. The caregiver will be shown exercises for patients to do to help recovery. This will be supported with 3 telephone calls and a workbook with activities for both the patient and caregiver. We will collect information on how well the project design worked in recruiting people, providing the training programme and collecting data. We will interview patients, caregivers and health professionals to see their views on the study. PATIENT AND PUBLIC INVOLVEMENT (PPI): The views of patients and caregivers have helped design this study. PPI members have helped with the study ideas, the proposed training programme and will help throughout the project. One of our co-applicants was a caregiver for his mother who had a hip fracture. DISSEMINATION: Results will be provided to health professionals and patients through published articles, conference presentations, social media blogs and newsletters. They will help the design of a larger trial to test the HIP HELPER programme in a wider population.

Research activity codes: 6.7 PHYSICAL
Health categories: MUSCULOSKELETAL