Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: A randomized controlled trial

Objective: To compare the effect of early discharge and home-based therapy with conventional hospital rehabilitation on patient and caregiver outcomes at 12 months after hip fracture. Design: Randomized controlled trial. Setting: Acute and subacute care with follow-up in a community setting in Australia. Participants: Sixty-six older adults admitted to acute care after hip fracture who were assessed as needing rehabilitation. Interventions: Eligible patients were randomized to either home-based (n=34) or hospital (n=32) rehabilitation. Patients assigned to the home-based group were discharged home Within 48 hours of randomization. Patients assigned to hospital rehabilitation received usual care. Main Outcome Measures: Modified Barthel Index (MBI), timed up and go (TUG) test, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index. Results: At 12 months, 56 of 66 (85%) participants were available for follow-up assessment. Both groups achieved significant improvements in MBI and TUG test scores. Patients in both groups had a significant decline in the physical score of the SF-36 and there were no differences between groups. Caregivers, of patients allocated to receive home-based therapy reported a reduction in burden after 12, months. Over that period, there was a significant reduction in the burden for caregivers of those patients who received home rehabilitation (P=.020). Conclusion: For patients who were previously functionally independent and living in the community, early return home with increased involvement of caregivers after hip fracture resulted in similar patient outcomes (home vs hospital) and less caregiver burden at 12 months. (C) 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.