Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: A prospective cohort study
Wing-Hoi Cheung, Wan-Yiu Shen, David Lok-Kwan Dai, Kin Bong Lee, Tracy Y. Zhu, Ronald Man-Yeung Wong, Kwok-Sui Leung
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, N/A Hong Kong, Hong Kong.
Objective: To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP) for fragility hip fracture patients.
Design: Prospective cohort study.
Patients: Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care. CFFMP provided geri-orthopaedic co-management, physician consultations, group-exercise and vibration-therapy. Timed-up-and-go test (TUG), Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and fall risk screening (FS) were used to assess functional performance. Incidences of falls and secondary fractures, the cost of the programme and related healthcare resources were recorded.
Results: A total of 76 patients were included in the intervention group (mean age 77.9 years ((standard deviation; SD) 6.1) ) and 77 in the control group (79.9 (SD 7.2)), respectively. The re-fracture rate in the control group (10.39%) was significantly higher than in the intervention group (1.32%) (p = 0.034). The intervention group improved significantly in TUG, EMS and FS after a 1-year programme. The overall healthcare costs per patient in the intervention and control groups were US$22,450 and US$25,313, respectively.
Conclusion: Multi-disciplinary CFFMP is effective, with reduced overall cost, reduced length of hospital stay and reduced secondary fracture rate. The rehabilitation community service favours rehabilitation and improved quality of life of hip fracture patients.
Geriatric hip fractures are a major burden and a socioeconomic threat to our society. Few studies have focused on the effectiveness of rehabilitation programs. Our study of 153 fragility hip fracture patients showed that an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP) reduced overall cost, length of hospital stay and secondary fracture rates. Each patient undergoing the program would save US$ 2,863 in hospital costs and have a reduced re-fracture rate of 1.32%. We would recommend the establishment of CFFMP for the rehabilitation for elderly hip fractures.