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'Home Sweet Home' Programme-2

Primary Purpose

Geriatric Hip Fracture

Status
Recruiting
Phase
Not Applicable
Locations
Hong Kong
Study Type
Interventional
Intervention
Tele-rehabilitation caregiver empowerment enhanced post- discharge rehabilitation directive
Sponsored by
The University of Hong Kong
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Geriatric Hip Fracture focused on measuring Empowerment, Telerehabilitation, Geriatric Hip Fractures, Functional outcomes

Eligibility Criteria

65 Years - undefined (Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Have provided informed consent to be included in the study Geriatrics ≥ 65 years of age Suffered hip fracture accompanied by successful surgery Less than 2 weeks following patient discharge from rehabilitation Less than four months post-operation Patients capable of walking on fracture without endangering their fracture fixation, Patients have been taught how to walk in the rehabilitation centre Caretaker/family has the ability to conduct the TUG test patient's residence is spacious enough to safely perform TUG test Video calling showing the performance of the TUG test should be supported Caretaker should have basic technological competency Caretaker should have sufficient cognitive ability to understand the TUG test Caretaker should have the ability to supervise patient during the TUG test Patients should have similar post-surgery recovery progress Record at the start if each patient requires assistance - with or without aid, e.g. walking frame etc Should at least have the potential to walk Exclusion Criteria: Patients with multiple fractures affecting mobility chair-bound or bed-bound Patients with severe cognitive impairment Assessed based on: unable to follow command to walk unable to identify time, person and space Presence of terminal illnesses/diseases Presence of multiple medical illnesses Determined by the Charleson comorbidity score Patients excluded if the score is larger or equal to 6

Sites / Locations

  • Queen Mary Hospital, The University of Hong KongRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Standard Group

Intervention Group

Arm Description

Usual clinical protocol is followed, the caregiver is given verbal training and assistive instructions by therapists and clinicians before patient discharge. Brief pamphlets are provided on post-operative care of patients. Patients are encouraged to perform rehabilitative exercises according to "what they have learned" during the in-patient stay. "Remote-TUG" app is only used in the first and final assessment at day 30.

A recruitment assessment videoconference is scheduled at the 1st post-discharge week providing clear instructions on how to perform daily TUG test. The TUG test is to be performed at least twice in the morning and twice afternoon and complimented by other specific training exercises as specified in HSH1. Training instructions and assessment is performed by videoconference to ascertain that both the patient and the caregiver can follow instructions in using the "remote-TUG" smartphone app and safety measures are understood and applied when assisting the patients in exercises. Clear video instructions and multimedia for review will be provided. Interim videoconference will be conducted again after week 2 to ascertain adherence. Non-adherence can be immediately detected by remote data collection from the "remote-TUG" server interface. Non-adherence will trigger phone calls and videoconferences serving as reminders and performing troubleshooting.

Outcomes

Primary Outcome Measures

Change in Walking function between Day 0 and Day 28
Timed-Up-and-Go (TUG) test

Secondary Outcome Measures

Change in Health-related quality of life between Day 0 and Day 28
The EQ5D-5L is a patient-reported outcome measure of health related, quality of life questionnaire. The scale measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each level is rated on scale that describes the degree of problems in that area. This tool also has an overall health scale where the rater selects a number between 1-100 to describe the condition of their health, 100 being the best imaginable.
Change in Patient's mobility measured by Parker Mobility Score between Day 0 and Day 28
The Parker Mobility Score is a composite measurement of the patient's mobility indoors, outdoors, and during shopping. It is a 3-item patient-reported measure, each item valued 0-3 points, the total score ranges from 0 (worst possible mobility) to 9 (best possible mobility)
Incidence of severe adverse events
Incidence of unplanned hospital readmissions, fall injury causing fractures, failure of internal fixation, death will be recorded

Full Information

First Posted
October 27, 2022
Last Updated
May 3, 2023
Sponsor
The University of Hong Kong
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1. Study Identification

Unique Protocol Identification Number
NCT05823129
Brief Title
'Home Sweet Home' Programme-2
Official Title
Effectiveness of Telerehabilitation on Quality of Life and Mobility of Early Post-discharge Hip Fracture Patients
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 15, 2022 (Actual)
Primary Completion Date
July 16, 2024 (Anticipated)
Study Completion Date
January 20, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The University of Hong Kong

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Objectives: To determine the effectiveness of telerehabilitation on the quality of life and mobility of early post-discharge in hip fracture patients, and to investigate whether telerehabilitation in the form of daily TUG tests recorded digitally will improve recovery outcomes for post-surgery hip fracture patients. Hypothesis to be tested: Main hypothesis: Caregiver empowerment can improve functional walking and quality of life at 1 month after discharge Secondary hypothesis: Hospital readmission and mortality rate can be reduced. Design and subjects: This is a prospective randomised controlled trial and subjects are fracture hip patients Instruments: Timed-Up-and-Go (TUG) test, EuroQol EQ5D-5L, Parker Mobility score Interventions: A videoconference scheduled at the 1st post-discharge week provides clear instructions and directions on how to perform daily exercise prescriptions based on the TUG test. Video instructions and multimedia for review will be provided. Interim videoconference will be conducted again after week 2 to ascertain adherence. Main outcome measures: Primary outcomes: Timed-Up-and-Go (TUG) test taken at day 0 and 28 Secondary outcome: EQ5D-3L and Parker Mobility Score taken on day 0 and 28 Other covariates Patient baseline demographics Classification of hip fractures Type of surgical intervention Comorbidities Any adverse events occurring: Severe adverse events including: unplanned hospital readmissions, fall injury causing fractures, failure of internal fixation, death Other adverse events including: unplanned clinic visits, complications requiring change in rehabilitation plan or additional medical/ surgical intervention, complications requiring closer observation Data analysis: Shapiro-Wilk test and independent sample t-test is performed for variables to ascertain normal distribution and compared for main outcomes. Binary variables and categorical variables with Chi-squared tests. Time-based outcomes are compared using Kaplan-Meier time to event analysis and log-rank test. A type 1 error rate / p value of 0.05 is used for statistical significance. Expected results: Fracture hip patients can be benefited from the empowerment program
Detailed Description
Rehabilitation after hip fracture surgery is crucial in the recovery process for hip fracture patients. Although huge emphasis has been placed on the importance of undertaking post-surgery daily exercise routines to patients, some patients still neglect these exercise routines due to various reasons, leading to insufficient recovery. The Geriatric Hip Fracture Clinical Pathway (GHFCP) is first designed and implemented in the Hong Kong West Cluster. The implementation of the GHFCP resulted in a decreased preoperative and total length of stay, decreased surgical site infection, decreased pressure sore, decreased 30-days and 12-months mortality rate. GHFCP specifically streamline acute and rehabilitation in-patient healthcare delivery and ends after the patient is discharged. Through many studies, telerehabilitation has proven to promote recovery in post-surgery patients, especially those that had undergone orthopaedic surgery. Present evidence indicates a strong positive effect for patients undergoing telerehabilitation post-orthoepaedic surgery, with a systematic review and meta-analysis suggesting that "increased intensity provided by telerehabilitation is a promising option to be offered to patients." At the same time, the Timed-up-and-Go (TUG) test has proven to be an accurate and objective assessment of the physical mobility of geriatric individuals. It is quick and easy to perform without the requirement for special equipment or training. When utilized as a descriptive tool, Timed-up-and-Go test data can detail a patient's balance, gait speed, and functional ability. As such, it is a suitable test to be utilized for telerehabilitation due to its easy operation and ability to communicate sufficient patient data, all of which can be done in a patient's own home and sent electronically through the internet to healthcare professionals. TUG when performs daily may incent by patients' adherence to rehabilitation in form of a biofeedback loop. With evidence displaying the effectiveness of the TUG test and telerehabilitation in their respective fields, this research aims to combine the two and provide telerehabilitation in the format of regular TUG tests in conjunction with an e-response system, encouraging patients to perform the exercise appropriately, thus improving their post-surgical outcomes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Geriatric Hip Fracture
Keywords
Empowerment, Telerehabilitation, Geriatric Hip Fractures, Functional outcomes

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Masking Description
A project manager will randomize the participants to the intervention or standard-care group, and the outcome assessor will not be informed
Allocation
Randomized
Enrollment
138 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Standard Group
Arm Type
No Intervention
Arm Description
Usual clinical protocol is followed, the caregiver is given verbal training and assistive instructions by therapists and clinicians before patient discharge. Brief pamphlets are provided on post-operative care of patients. Patients are encouraged to perform rehabilitative exercises according to "what they have learned" during the in-patient stay. "Remote-TUG" app is only used in the first and final assessment at day 30.
Arm Title
Intervention Group
Arm Type
Experimental
Arm Description
A recruitment assessment videoconference is scheduled at the 1st post-discharge week providing clear instructions on how to perform daily TUG test. The TUG test is to be performed at least twice in the morning and twice afternoon and complimented by other specific training exercises as specified in HSH1. Training instructions and assessment is performed by videoconference to ascertain that both the patient and the caregiver can follow instructions in using the "remote-TUG" smartphone app and safety measures are understood and applied when assisting the patients in exercises. Clear video instructions and multimedia for review will be provided. Interim videoconference will be conducted again after week 2 to ascertain adherence. Non-adherence can be immediately detected by remote data collection from the "remote-TUG" server interface. Non-adherence will trigger phone calls and videoconferences serving as reminders and performing troubleshooting.
Intervention Type
Behavioral
Intervention Name(s)
Tele-rehabilitation caregiver empowerment enhanced post- discharge rehabilitation directive
Intervention Description
The intervention group will receive an implemented TUG test-based telerehabilitation program. The TUG test-based telerehabilitation involves patients routinely doing two TUG tests by themselves twice daily. Each patient will be provided with a unique link to the TUGstopwatch, a prerecorded video outlining instructions on how to properly conduct a TUG test, and support and guidance for patients and caregivers throughout the study period.
Primary Outcome Measure Information:
Title
Change in Walking function between Day 0 and Day 28
Description
Timed-Up-and-Go (TUG) test
Time Frame
Change in TUG test between Day 0 and Day 28
Secondary Outcome Measure Information:
Title
Change in Health-related quality of life between Day 0 and Day 28
Description
The EQ5D-5L is a patient-reported outcome measure of health related, quality of life questionnaire. The scale measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each level is rated on scale that describes the degree of problems in that area. This tool also has an overall health scale where the rater selects a number between 1-100 to describe the condition of their health, 100 being the best imaginable.
Time Frame
Change in quality of life between Day 0 and Day 28
Title
Change in Patient's mobility measured by Parker Mobility Score between Day 0 and Day 28
Description
The Parker Mobility Score is a composite measurement of the patient's mobility indoors, outdoors, and during shopping. It is a 3-item patient-reported measure, each item valued 0-3 points, the total score ranges from 0 (worst possible mobility) to 9 (best possible mobility)
Time Frame
Change in mobility score between Day 0 and Day 28
Title
Incidence of severe adverse events
Description
Incidence of unplanned hospital readmissions, fall injury causing fractures, failure of internal fixation, death will be recorded
Time Frame
Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Have provided informed consent to be included in the study Geriatrics ≥ 65 years of age Suffered hip fracture accompanied by successful surgery Less than 2 weeks following patient discharge from rehabilitation Less than four months post-operation Patients capable of walking on fracture without endangering their fracture fixation, Patients have been taught how to walk in the rehabilitation centre Caretaker/family has the ability to conduct the TUG test patient's residence is spacious enough to safely perform TUG test Video calling showing the performance of the TUG test should be supported Caretaker should have basic technological competency Caretaker should have sufficient cognitive ability to understand the TUG test Caretaker should have the ability to supervise patient during the TUG test Patients should have similar post-surgery recovery progress Record at the start if each patient requires assistance - with or without aid, e.g. walking frame etc Should at least have the potential to walk Exclusion Criteria: Patients with multiple fractures affecting mobility chair-bound or bed-bound Patients with severe cognitive impairment Assessed based on: unable to follow command to walk unable to identify time, person and space Presence of terminal illnesses/diseases Presence of multiple medical illnesses Determined by the Charleson comorbidity score Patients excluded if the score is larger or equal to 6
Facility Information:
Facility Name
Queen Mary Hospital, The University of Hong Kong
City
Hong Kong
Country
Hong Kong
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Christian Xinshuo Fang
Phone
22554581
Email
cfang@hku.hk
First Name & Middle Initial & Last Name & Degree
Christian Xinshuo Fang

12. IPD Sharing Statement

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'Home Sweet Home' Programme-2

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