High Intensity Physiotherapy for Hip Fractures

Study Overview
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Brief Summary
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Every day, more than 40 Australian break their hip, Most are over the age of sixty five. Hip fractures are a significant problem for the older people, the hospital system and community as a whole because of the increasing numbers of fractures and the cost of hospitalisation and ongoing care. After one year, less than half of all people with a hip fracture can walk as well as they did before the fracture. Physiotherapy in the acute hospital setting is an integral part of patient care, although the intensity of physiotherapy a patient receives is variable and the optimal number of treatment sessions per day remains unknown. Studies in other patient groups have shown that increased physiotherapy can improve patient outcomes by increasing muscle strength and mobility. It can also reduce the negative effects of bed rest such as muscle wasting, blood clots in the lungs or leg veins and chest infections such as pneumonia. This study aims to investigate the effectiveness of an intensive physiotherapy program in hip fracture patients to further understand this and the effect it has on patient function. In this research the investigators will randomly allocate patients into 2 groups; usual care and intensive physiotherapy. The usual care group will have physiotherapy treatment daily whereas the intensive physiotherapy group will have an additional daily treatment by a physiotherapist as well as a daily treatment by an allied health assistant. The objectives are to achieve better functional outcomes in the patient's hospital stay (ie improved mobility), reduce the time for patients to be physically ready to go home, increase the number of patients able to go directly home or to fast stream rehabilitation (rather than a slow stream option). If increased intensity of physiotherapy is found to improve patient's mobility outcomes, this research will provide the confidence to endorse a change to current clinical practice.

Official Title
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High Intensity Physiotherapy for Hip Fractures in the Acute Hospital Setting

Conditions
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Hip Fractures

Intervention / Treatment
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* Other: Intensive physiotherapy
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Admission to The Alfred with an isolated hip fracture and treated with internal fixation, aged 65 or above Exclusion Criteria: fracture is in the sub-trochanteric region of the femur, if it is pathological, if post operative orders are for non-weight bearing on the operated hip, if they were unable to mobilise independently (or with gait aid) prior to admission, or if they were admitted from a nursing home.

Ages Eligible for Study
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Minimum Age: 65 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
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Usual care<br>usual care physiotherapy - once daily treatment whilst inpatient in acute hospital | Other: Usual Care<br>* once daily physiotherapy whilst acute hospital inpatient<br>|
| Experimental: Intensive physiotherapy<br>additional once daily physiotherapy and once daily allied health assistant intervention | Other: Intensive physiotherapy<br>* additional once daily physiotherapy and once daily allied health assistant intervention (equals two more treatments) whilst an inpatient in acute hospital<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| modified IOWA Level of Assistance Scale | Functional score measuring 6 mobility domains | 5 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| length of stay - acute and rehabilitation | the length of acute hospital stay and rehabilitation stay - until discharge home or to a long term facility | participants will be followed for duration of hospital stay - average one month | 
| timed up and go |  | 5 days | 
| Glasgow Outcomes Score -Extended |  | 6 months | 
| discharge destination | discharge destination from the acute hospital - options include: home, fast stream rehabilitation, slow stream rehabilitation, long term facility | participants will be followed until discharge from the acute hospital - average 10 days | 
| physical readiness for discharge | when a patient is deemed physically ready go home - eg can access their house and mobilise within house and outdoors | average one month | 
| 12-Item Short Form Health Survey (SF-12) |  | 6 months | 
| EuroQOL five dimensions questionnaire (EQ-5D) |  | 6 months |