Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial

English version

Autoři: Kristin Taraldsen ^aff001; Pernille Thingstad ^aff001; Øystein Døhl ^aff002; Turid Follestad ^aff003; Jorunn L. Helbostad ^aff001; Sarah E. Lamb ^aff004; Ingvild Saltvedt ^aff001; Olav Sletvold ^aff001; Vidar Halsteinli ^aff003
Působiště autorů: Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway ^aff001; Trondheim Municipality, Trondheim, Norway ^aff002; Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Trondheim, Norway ^aff003; Oxford University, Oxford, United Kingdom ^aff004; Department of Geriatrics, St.Olavs University Hospital, Trondheim, Norway ^aff005; Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway ^aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224971

Souhrn

The aim of this trial was to evaluate the clinical effectiveness and cost-effectiveness of a home-based exercise program delivered four months following hip-fracture surgery. In the two-armed randomized, single blinded clinical trial we included persons who lived in the catchment area, were 70 years or older, and community-dwelling at time of the fracture. We excluded persons who were unable to walk ten meters prior to the fracture, and those who were bedridden or had medical contraindications for exercise at baseline (ie. four months after the fracture). All participants underwent routine treatment and rehabilitation. The intervention group received additional 20 sessions (10 weeks) structured, home exercise targeting gait and balance, delivered by physiotherapists in primary health care. Gait speed was the primary outcome. Secondary outcomes included physical activity, gait characteristics, cognitive function, activities of daily living, health-related quality of life, and health care costs extracted from hospital and municipality records. In total, 223 participants were included. Four months post surgery 143 were randomized for the exercise trial (70% women, mean age 83.4 (SD 6.1) years, mean gait speed 0.6 (SD 0.2) m/sec). Estimated between group difference in gait speed was 0.09 m/sec (95% CI: 0.04 to 0.14, p<0.001) at posttest and 0.07 m/sec (95% CI: 0.02 to 0.12, p = 0.009) 12 months post surgery. The mean between-group QALY difference was -0.009 (95% CI: -0.061 to 0.038). The mean between-group total cost difference was +242.9 EUR (95% CI: -8397 to 8584). Our findings suggest that gait recovery after hip fracture can be improved by introducing a home-based balance and gait exercise program four months post surgery, without increasing total health care costs. Future research should focus on how to implement gait and balance exercise in comprehensive interventions that increase adherence among the most vulnerable persons and have an effect on daily life activities and patient-centred outcomes.

Trial registration: ClinicalTrials.gov NCT01379456.

Klíčová slova:

Activities of daily living – Allied health care professionals – Cost-effectiveness analysis – Exercise – Hip – Nursing homes – Strength training – Walking

Zdroje

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Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial

Souhrn

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