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BACKGROUND: The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive behavioral treatment (CBT) improves recovery. The same holds for sensor monitoring-based coaching in addition to OT. Here, we describe the design of a study investigating the effect of sensor monitoring embedded in an OT rehabilitation program on the recovery of ADL among older individuals after hip fracture.METHODS/ DESIGN: Six nursing homes will be randomized in a three-arm stepped wedge cluster randomized trial. All nursing homes will initially provide standard care. At designated time points, nursing homes, successively and in random order, will cross over to the provision of OT and at the next time point, to sensor monitoring-enhanced OT. A total of 288 older individuals, previously living alone in the community, who after a hip fracture were admitted to a geriatric rehabilitation ward for a short-term rehabilitation, will be enrolled. Individuals in the first intervention group (OTc) will participate in an OT rehabilitation program with coaching based on cognitive behavioral therapy (CBT) principles. In the sensor monitoring group, sensor monitoring is added to the OT intervention (OTcsm). Participants will receive a sensor monitoring system consisting of (i) an activity monitor during nursing home stay, (ii) a sensor monitoring system at home and a (iii) a web-based feedback application. These components will be embedded in the OT. The OT consists of a weekly session with an occupational therapist during the nursing home stay followed by four home visits and four telephone consultations. The primary outcome is patient-perceived daily functioning at 6 months, assessed using the Canadian Occupational Performance Measure (COPM).DISCUSSION: As far as we know, this study is the first large-scale stepped wedge trial, studying the effect of sensor monitoring embedded in an OT coaching program. The study will provide new knowledge on the combined intervention of sensor monitoring and coaching in OT as a part of a rehabilitation program to enable older individuals to perform everyday activities and to remain living independently after hip fracture.TRIAL REGISTRATION NUMBER: Netherlands National Trial Register, NTR 5716 Date registered: April 1 2016.
The aim of this study was to gain insight into the nutritional status, dietary intake and muscle health of older Dutch hip fracture patients to prevent recurrent fractures and to underpin rehabilitation programs. This cross-sectional study enrolled 40 hip fracture patients (mean ± SD age 82 ± 8.0 years) from geriatric rehabilitation wards of two nursing homes in the Netherlands. Assessments included nutritional status (Mini Nutritional Assessment), dietary intake on three non-consecutive days which were compared with Dietary Reference Intake values, and handgrip strength. Muscle mass was measured using Bioelectrical Impedance Analysis and ultrasound scans of the rectus femoris. Malnutrition or risk of malnutrition was present in 73% of participants. Mean energy, protein, fibre and polyunsaturated fat intakes were significantly below the recommendations, while saturated fat was significantly above the UL. Protein intake was
OBJECTIVES: to test the effects of an intervention involving sensor monitoring-informed occupational therapy on top of a cognitive behavioural treatment (CBT)-based coaching therapy on daily functioning in older patients after hip fracture.DESIGN, SETTING AND PATIENTS: three-armed randomised stepped wedge trial in six skilled nursing facilities, with assessments at baseline (during admission) and after 1, 4 and 6 months (at home). Eligible participants were hip fracture patients ≥ 65 years old.INTERVENTIONS: patients received care as usual, CBT-based occupational therapy or CBT-based occupational therapy with sensor monitoring. Interventions comprised a weekly session during institutionalisation, followed by four home visits and four telephone consultations over three months.MAIN OUTCOMES AND MEASURES: the primary outcome was patient-reported daily functioning at 6 months, assessed with the Canadian Occupational Performance Measure.RESULTS: a total of 240 patients (mean[SD] age, 83.8[6.9] years were enrolled. At baseline, the mean Canadian Occupational Performance Measure scores (range 1-10) were 2.92 (SE 0.20) and 3.09 (SE 0.21) for the care as usual and CBT-based occupational therapy with sensor monitoring groups, respectively. At six months, these values were 6.42 (SE 0.47) and 7.59 (SE 0.50). The mean patient-reported daily functioning in the CBT-based occupational therapy with sensor monitoring group was larger than that in the care as usual group (difference 1.17 [95% CI (0.47-1.87) P = 0.001]. We found no significant differences in daily functioning between CBT-based occupational therapy and care as usual.CONCLUSIONS AND RELEVANCE: among older patients recovering from hip fracture, a rehabilitation programme of sensor monitoring-informed occupational therapy was more effective in improving patient-reported daily functioning at six months than to care as usual.TRIAL REGISTRATION: Dutch National Trial Register, NTR 5716.
OBJECTIVE: to gain insight into what older adults after hip fracture perceive as most beneficial to their recovery to everyday life.DESIGN: qualitative research approach.SETTING: six skilled nursing facilities.PARTICIPANTS: 19 older community dwelling older adults (aged 65-94), who had recently received geriatric rehabilitation after hip fracture.METHODS: semi-structured interviews were conducted with 19 older adults after hip fracture. Coding techniques based on constructivist grounded theory were applied.RESULTS: four categories were derived from the data: 'restrictions for everyday life', 'recovery process', 'resources for recovery' and 'performing everyday activities'. Physical and psychological restrictions are consequences of hip fracture that older adults have struggled to address during recovery. Three different resources were found to be beneficial for recovery; 'supporting and coaching', 'myself' and 'technological support'. These resources influenced the recovery process. Having successful experiences during recovery led to doing everyday activities in the same manner as before; unsuccessful experiences led to ceasing certain activities altogether.CONCLUSION: participants highlight their own role ('myself') as essential for recovery. Additionally, coaching provides emotional support, which boosts self-confidence in performing everyday activities. Furthermore, technology can encourage older adults to become more active and being engaged in the recovery process. The findings suggest that more attention should be paid to follow-up interventions after discharge from inpatient rehabilitation to support older adults in finding new routines in their everyday activities.A conceptual model is presented and provides an understanding of the participants' experiences and perspectives concerning their process of recovery after hip fracture to everyday life.
Abstract: Background: Hip fracture in older patients often lead to permanent disabilities and can result in mortality. Objective: To identify distinct disability trajectories from admission to one-year post-discharge in acutely hospitalized older patients after hip fracture. Design: Prospective cohort study, with assessments at admission, three-months and one-year post-discharge. Setting and participants: Patients ≥ 65 years admitted to a 1024-bed tertiary teaching hospital in the Netherlands. Methods: Disability was the primary outcome and measured with the modified Katz ADL-index score. A secondary outcome was mortality. Latent class growth analysis was performed to detect distinct disability trajectories from admission and Cox regression was used to analyze the effect of the deceased patients to one-year after discharge. Results: The mean (SD) age of the 267 patients was 84.0 (6.9) years. We identified 3 disability trajectories based on the Katz ADL-index score from admission to one-year post-discharge: ‘mild’- (n=54 (20.2%)), ‘moderate’- (n=110 (41.2%)) and ‘severe’ disability (n=103 (38.6%)). Patients in all three trajectories showed an increase of disabilities at three months, in relation to baseline and 80% did not return to baseline one-year post-discharge. Seventy-three patients (27.3%) deceased within one-year post-discharge, particularly in the ‘moderate’- (n=22 (8.2%)) and ‘severe’ disability trajectory (n=47 (17.6%)). Conclusions: Three disability trajectories were identified from hospital admission until one-year follow-up in acutely hospitalized older patients after hip fracture. Most patients had substantial functional decline and 27% of the patient’s deceased one-year post-discharge, mainly patients in the ‘moderate’- ‘and severe’ disability trajectories.
