Background: Fall-related hip fractures result in significant personal and societal consequences; importantly, up to half of older adults with hip fracture never regain their previous level of mobility. Strategies of follow-up care for older adults after fracture have improved investigation for osteoporosis; but managing bone health alone is not enough. Prevention of fractures requires management of both bone health and falls risk factors (including the contributing role of cognition, balance and continence) to improve outcomes. Methods/Design. This is a parallel group, pragmatic randomized controlled trial to test the effectiveness of a post-fracture clinic compared with usual care on mobility for older adults following their hospitalization for hip fracture. Participants randomized to the intervention will attend a fracture follow-up clinic where a geriatrician and physiotherapist will assess and manage their mobility and other health issues. Depending on needs identified at the clinical assessment, participants may receive individualized and group-based outpatient physiotherapy, and a home exercise program. Our primary objective is to assess the effectiveness of a novel post-discharge fracture management strategy on the mobility of older adults after hip fracture. We will enrol 130 older adults (65 years+) who have sustained a hip fracture in the previous three months, and were admitted to hospital from home and are expected to be discharged home. We will exclude older adults who prior to the fracture were: unable to walk 10 meters; diagnosed with dementia and/or significant comorbidities that would preclude their participation in the clinical service. Eligible participants will be randomly assigned to the Intervention or Usual Care groups by remote allocation. Treatment allocation will be concealed; investigators, measurement team and primary data analysts will be blinded to group allocation. Our primary outcome is mobility, operationalized as the Short Physical Performance Battery at 12 months. Secondary outcomes include frailty, rehospitalizations, falls risk factors, quality of life, as well as physical activity and sedentary behaviour. We will conduct an economic evaluation to determine health related costs in the first year, and a process evaluation to ascertain the acceptance of the program by older adults, as well as clinicians and staff within the clinic.
Bibliographical noteFunding Information:
The B4 Research Team would like to thank all the clinicians and staff at St. Paul’s Hospital and Vancouver Acute Hospital for their support and expert guidance in the development of this trial. In addition, we would also like to thank staff and colleagues at the Centre for Hip Health and Mobility for ongoing support and development of this project. We are grateful to the Canadian Institutes of Health Research (CIHR) for operational support (CIHR DPA – 99051) of this study and the New Investigator Award (MCA). We would also like to acknowledge the St. Paul’s Hospital Foundation for salary support (WLC) and the Michael Smith Foundation for Health Research (MSFHR) for Career Award support (MCA). Finally, we would also like to acknowledge the support of the British Columbia Network for Aging Research who provided early funds to investigate older adults’ recovery processes that formed the basis for this research program.