Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): results of a phase II randomised feasibility study of a multidisciplinary rehabilitation package following proximal hip fracture

Talk Code: 
EP2C.2

The problem

Proximal femoral fracture is a common, major health problem in old age resulting in loss of functional independence and a high cost burden on society, with estimated health and social care costs of £2.3 billion per year in the UK. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of effectiveness is lacking. Usual rehabilitation care is delivered by a multi-disciplinary team in hospital and the community. An enhanced rehabilitation intervention has been developed consisting of a workbook, goal setting diary and extra therapy sessions in the community, designed to improve self-efficacy and increase the amount and quality of the practice of physical exercise and activities of daily living.

The approach

A phase II study comprising an anonymous cohort of all proximal femoral fracture patients admitted to the three acute hospitals in Betsi Cadwaladr University Health Board, and a randomised feasibility study comparing the enhanced rehabilitation intervention with usual care. These will assess the feasibility of a future definitive randomised controlled trial and concurrent economic evaluation in terms of recruitment, retention, outcome measure completion, compliance with the intervention and fidelity of delivery, health service use data, willingness to be randomised and effect size for a future sample size calculation. Focus groups will provide qualitative data to contribute to the assessment of the acceptability of the intervention among patients, carers and rehabilitation professionals and the feasibility of delivering the planned intervention. The primary outcome measure is function assessed by the Barthel Index. Secondary outcomes measure the ability to perform activities of daily living, anxiety and depression, potential mediators of outcomes such as hip pain, self-efficacy and fear of falling, health utility, health service use, objectively assessed physical function and adverse events. Participants' preference for rehabilitation is being assessed in a discrete choice experiment.

Findings

Up until the end of January 2015 485 patients had been screened. Out of these 266 were ineligible (lack of capacity 140, living in residential accommodation 51, too young 28, outside area 27, no surgery 16); 221 were eligible and 45 (20%) had been recruited. One hundred and seventy six eligible patients were not recruited (died 10, medically unwell 20, discharged before approached 20, outside of areas where intervention can be delivered 17, declined 81 of which 33 said that the study was too burdensome). Recruitment will continue until the end of March 2015. The final retention and recruitment rates will be presented as will descriptive statistics of the primary and secondary outcome measures.Consequence The results will be discussed in terms of the acceptability of the intervention and the feasibility of conducting a larger definitive randomised controlled trial.

Credits

  • Nefyn Williams, Betsi Cadwaladr University Health Board, North Wales, UK
  • Claire Hawkes, Betsi Cadwaladr University Health Board, North Wales, UK
  • Nafees Ud Din, Betsi Cadwaladr University Health Board, North Wales, UK
  • Jessica Roberts, Betsi Cadwaladr University Health Board, North Wales, UK
  • Joanna Charles, Betsi Cadwaladr University Health Board, North Wales, UK
  • Val Morrison, Betsi Cadwaladr University Health Board, North Wales, UK
  • Zoe Hoare, Betsi Cadwaladr University Health Board, North Wales, UK
  • Rhiannon Edwards, Betsi Cadwaladr University Health Board, North Wales, UK
  • Glynne Andrew, Kings College London, London, UK
  • Swapna Alexander, Kings College London, London, UK
  • Andrew Lemmey, Betsi Cadwaladr University Health Board, North Wales, UK
  • Bob Woods, Betsi Cadwaladr University Health Board, North Wales, UK
  • Catherine Sackley, University of Nottingham, Nottingham, UK
  • Pip Logan
  • David Hunnisett, Betsi Cadwaladr University Health Board, North Wales, UK
  • Kevin Mawdesley, Betsi Cadwaladr University Health Board, North Wales, UK
  • Clare Wilkinson, Betsi Cadwaladr University Health Board, North Wales, UK