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Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial
M E Tinetti1, D I Baker, M Gottschalk
1Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
Objective:
To determine whether a home-based systematic multicomponent rehabilitation strategy leads to improved outcomes relative to usual care.
Design:
A randomized controlled trial with 12 months of follow-up.
Setting:
General community; 27 home care agencies.
Participants:
Three hundred four nondemented persons at least 65 years of age who underwent surgical repair of a hip fracture at two hospitals in New Haven, CT, and returned home within 100 days.
Intervention:
Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments (physical therapy) and activities of daily living (ADL) disabilities (functional therapy) versus usual care.
Main Outcome Measures:
A battery of self-report and performance-based measures of physical and social function.
Results:
There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months (71% vs 75%) or 12 months (74% in both groups) or in home management ADL at 6 months (35% vs 44%) or 12 months (44% vs 48%). There also was no difference between the two groups in social activity levels, two timed mobility tasks, balance, or lower extremity strength at either 6 or 12 months. Compared with participants who received usual care, those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months (p = .04) and a marginally better gait performance (p = .08).
Conclusions:
The systematic multicomponent rehabilitation program was no more effective in promoting recovery than usual home-based rehabilitation. Compared with previous cohorts, however, participants randomized to usual care in our study received more rehabilitative and home care services and experienced a higher rate of recovery. This finding is important given the current pressures to reduce home services. The challenge is to determine the composition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fracture.
