Shams Dakhil1,2, Pernille Thingstad3, Frede Frihagen4, Lars Gunnar Johnsen3,5,6, Stian Lydersen7, Eva Skovlund8, Torgeir Bruun Wyller9,10, Olav Sletvold3,11, Ingvild Saltvedt3,11, Leiv Otto Watne9. 1. Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. shams.dakhil@studmed.uio.no. 2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. shams.dakhil@studmed.uio.no. 3. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 4. Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway. 5. Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 6. Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. 7. Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 8. Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 9. Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. 10. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 11. Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Abstract
BACKGROUND: The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). METHODS: This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. RESULTS:Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients receivedCGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. CONCLUSIONS: Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
RCT Entities:
BACKGROUND: The incidence of hip fractures are expected to increase in the following years. Hip fracturepatients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). METHODS: This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. RESULTS: Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. CONCLUSIONS: Merged data of two randomized controlled trials showed that admitting hip fracturepatients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
Entities:
Keywords:
Activities of Daily living (ADL); Hip fracture; Orthogeriatric
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