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Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial

Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daw Park, Australia; maria.crotty{at}flinders.edu.au

Craig H Whitehead

Steven Gray

Paul M Finucane

Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daw Park, Australia

Objective: To compare hospital and home settings for the rehabilitation of patients following hip fracture.

Design: Randomized controlled trial comparing accelerated discharge and home-based rehabilitation (n = 34) with conventional hospital care (n = 32) for patients admitted to hospital with hip fracture.

Setting: Three metropolitan hospitals in Adelaide, Australia. Subjects: Sixty-six patients with fractured hip. Interventions: Patients assigned to the home-based rehabilitation group were discharged within 48 hours of randomization. The project team therapists made visits to the patient’s home and negotiated a set of realistic, short-term and measurable treatment goals with both the patient and carer. Those randomized to usual care remained in hospital for conventional rehabilitation.

Main outcome measures: Physical and social dependence, balance con"dence, quality of life, carer strain, patient and carer satisfaction, use of community services and incidence of adverse events such as re-admission and falls.

Results: While there was no difference between the groups for all measures of quality of life, patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from randomization (p < 0.05) and scored higher on the Falls Ef"cacy Scale (p < 0.05) at four months. There was no difference in falls rates. Patients in the home-based rehabilitation group had a shorter stay in hospital (p < 0.05) but a longer stay in rehabilitation overall (p < 0.001). The groups were comparable on the rate and length of admissions after discharge, use of community services, need for carer input and contact with general practitioner (GP) after discharge.

Clinical Rehabilitation, Vol. 16, No. 4, 406-413 (2002)
DOI: 10.1191/0269215502cr518oa


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