Clinical trial NCT03906864: Care Pathway for Sub-acute Hip Rehabilitation
Official title: Integrated Care Pathway for Hip Fractures in a Subacute Rehabilitation Setting
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hip Fractures
Keywords: Critical pathway, length of stay, recovery of function, subacute care
Lead sponsor: St Luke's Hospital, Singapore
Sponsor class: OTHER
Collaborators: name: National University of Singapore
First posted: 2019-04-08
Enrollment: 162
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The effectiveness of integrated care pathways for hip fractures in sub-acute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a sub-acute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. A randomised controlled trial on an integrated care pathway was conducted for hip fracture patients in a sub-acute rehabilitation setting. The study supports the use of integrated care pathways in sub-acute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.

Detailed description: All patients admitted to St Luke's Hospital, a 185-bed hospital in Singapore providing multidisciplinary stepdown care, from 8 September 2004 to 14 June 2006 for the purpose of rehabilitation after a new hip fracture were included. Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial. Administrative staff allocated patients to either ICP or usual care according to the last digit of their National Registration Identity Card (NRIC) numbers, odd numbers to the intervention group and even numbers to the control group. Patients were then admitted to 1 of 2 intervention wards or 1 of 3 control wards. Patients were enrolled by the principal investigators only after moving into their respective wards because of work flow limitations. Those who refused consent or were excluded remained in their assigned wards and received usual care. Both intervention and control groups were under the care of multidisciplinary teams but the intervention group had structured assessments and checklists in addition to usual care while the control group had usual care alone.

Eligibility criteria: Inclusion Criteria:

* Patients admitted to St Luke's Hospital for the purpose of rehabilitation after a new hip fracture.

Exclusion Criteria:

* Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial.

Primary outcomes:
measure: Montebello Rehabilitation Factor Score (MRFS)
timeFrame: 1 day At discharge
measure: Montebello Rehabilitation Factor Score (MRFS)
timeFrame: At 6 months
measure: Montebello Rehabilitation Factor Score (MRFS)
timeFrame: At 1 year
measure: Proportions of patients achieving pre-morbid ambulatory status
timeFrame: 1 day At discharge
measure: Proportions of patients achieving pre-morbid ambulatory status
timeFrame: At 6 months
measure: Proportions of patients achieving pre-morbid ambulatory status
timeFrame: At 1 year
measure: Length of stay in hospital
timeFrame: 1 day At discharge
measure: Percentage of patients admitted to nursing home
timeFrame: Up to 1 year after discharge
Secondary outcomes:
measure: Readmissions to an acute hospital for any reason
timeFrame: up to 1-year post-discharge
measure: Cumulated mortality
timeFrame: 1 year
measure: Quality of life scale-Short form 12 quality of life
timeFrame: 6 months and 1 year
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: St Luke's Hospital, Singapore
Study officials:
affiliation: National University of Singapore
name: Tze Pin Ng, FAMS, PhD
role: STUDY_CHAIR
References:
citation: Handoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2021 Nov 12;11(11):CD007125. doi: 10.1002/14651858.CD007125.pub3.