Motivational Interventions and Physical Exercise in Patients With Fragility Fracture

Study Overview
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Brief Summary
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Patients with a fragility fracture are twice as likely to have future fractures compared to their non-fractured peers. Furthermore, the 30% who suffer a fragility fracture do not regain the level of functioning in terms of activities of daily living after one year. A recent ecological study, in several European countries, estimates that if fracture patients were enrolled in fracture follow-up services, at least 19,000 fractures could be prevented each year. Clinical trials carried out in the research group have shown that the prescription of physical exercise in severe underlying pathologies is effective in improving physical function, quality of life and long-term results. Hypothesis: The implementation of a motivational intervention and physical exercise program, in a staggered manner, taking into account the basic exercise capacity, improves the functional status of the patient (basic activities of daily life), adherence to interventions and the level of physical activity, and therefore reduces the number of hospital admissions, refractures and other associated complications. Objective: To evaluate the effect of a rehabilitation intervention based on physical exercise and motivation, applied in a staggered manner and according to the functional capacity of patients with fragility fracture.

Detailed Description
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Method: Single-blind, randomized, controlled clinical study, with 2 parallel arms and single-center. Study subjects: Patients who underwent surgery for a fragility hip fracture between September 2021 and September 2022 in a tertiary hospital in southern Spain. A progressive physical exercise and motivational intervention adjusted for functional capacity will be compared versus usual rehabilitation care. Follow-up of patients for 3 months and a final visit at 6 months. The primary outcome variables will be functional status for the development of activities of daily living (individual ability to care for himself) and number of hospital readmissions (reasons and consequences). Variables related to quality of life, cognitive status, laboratory markers and densitometry will also be analyzed.

Official Title
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Effectiveness of a Follow-up Program Based on Motivational Interventions and Physical Exercise in Patients With Fragility Fracture: Randomized Controlled Clinical Trial.

Conditions
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Fragility Fracture

Intervention / Treatment
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* Behavioral: Physical and motivational follow-up treatment
* Behavioral: Usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Present a hip fracture (includes cervical fracture and trochanteric), classified in the 10th version of the International Classification of Diseases (ICD-10-ES) with codes S72-S72.26X; In addition, the fracture must be due to fragility: fracture due to a low-energy trauma or not proportional to the consequences (Hermoso de Mendoza, 2003); To have received a surgical repair by replacement arthroplasty or internal fixation (ICD-10-ES procedures: 0SU and 0SR) in a period of less than one week; To be recovering in a trauma and orthopedic unit and/or be transferred to a rehabilitation unit or discharged; Before the fracture, independent or mild dependence for activities of daily living (Barthel index> 60) and living at home; To have the cognitive ability to give informed consent (ANNEX I); To live and be domiciled in a basic health area covered by the study hospital complex To be over 50 years of age Exclusion Criteria: Presence of low cognitive level (scores below 23 points in Lobo's Mini-cognitive exam); Patients with pathological fractures due to skeletal alterations other than osteoporosis; Presence of more than one fall (other than the cause of hospital admission) in the last year; Presence of uncorrected anemia (hemoglobin concentration <9/dL), acute infectious disease (C-reactive protein> 10 mg / L), severe cardiorespiratory disease (for example: unstable angina; severe heart failure identified by the New York Heart Association as class III-IV), musculoskeletal or neurological diseases (for example, major amputation of lower limbs) that make physical exercise impossible.

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physical activity program and motivational intervention<br>Physical activity program agreed with the patient / family and according to functional status (based on the 6-minute walk test) and motivational intervention. In addition to the care provided in usual care, a progressive physical exercise program based on basal functional capacity is prescribed. The exercise will be developed at home. | Behavioral: Physical and motivational follow-up treatment<br>* Physical and motivational follow-up treatment<br>|
| Active Comparator: Treatment as usual<br>Multidisciplinary rehabilitation provided by professionals in the hospital and primary care settings, according to the individual needs of patients at different times of their recovery and the accessibility and availability of services in the different care settings. | Behavioral: Usual care<br>* Usual rehabilitation program<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Barthel index | Functional status for the development of activities of daily living (individual ability to take care of himself) | 6 months | 
| Number of hospital readmissions | Other clinical outcomes, such as mortality and all-cause hospitalization, | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mini-Mental State Examination | A 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment | 6 months | 
| Minnesota Leisure Time Physical Activity Questionnaire | To assess the quantity (total activity metabolic index) and quality (heavy, moderate, and light) of physical activity performed | 6 months | 
| Geriatric Depression Scale | is a brief, 30-item questionnaire in which participants are asked to respond by answering yes or no in reference to how they felt over the past week | 6 months | 
| Visual analogue scale | A validated, subjective measure for acute and chronic pain | 6 months | 
| Falls Efficacy Scale-International | It is a 16 item questionnaire, useful to the researchers and clinicians interested in fear of falling, with a score ranging from minimum 16 (no concern about falling) to maximum 64 (severe concern about falling) | 6 months | 
| 5-level EQ-5D version | A standardised measure of health-related quality of life | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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fragility fracture, physical exercise, motivational intervention