Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial
Kennie, D.C.; Reid, J.; Richardson, I.R.; Kiamari, A.A.; Kelt, C.
Bmj 297(6656): 1083-1086
1988
ISSN/ISBN: 0959-8138 PMID: 3143436 Document Number: 313581
Objective-To compare postoperative collaborative care between orthopaedic surgeons and physicians in geriatric medicine with routine ortheopaedic care in elderly women with proximal femoral fracture. Design-Exclusion of patient dying before fit enough to enter trial, those with pathological fractures, those likely to be discharged within seven days of entering the trial, and those remaining unfit for transfer to a peripheral hospital. Reminder allocated to two groups: treatment group and control group. Setting-District hospital acute admission ward and rehabilitation ward. Patients-144 sequentially admitted elderly women with proximal fracture of the femur; 36 excluded on above criteria and remainder entered into trail. Intervention-Both treatment and control groups (n = 54 in each) received physiotherapy and other services. The treatment group also received thrice weekly supervision by a geriatrician. End points-Physical independence, residence after discharge, and length of hospital stay. Measurements and main results- At discharge significantly more patients in treatment group were independent in terms of activities of daily living than controls (41 v 25) and their median stay was 24 days (range 8-197) compared with 41 (9-365) (95% confidence intervals for difference 2 to 25). Significantly fewer treatment patients were discharged to institutional care (10% v 32%, 95% confidence interval for difference 6% to 37%) and more to their own homes (63% v 38%; 95% confidence interval for difference 6% to 44%). These beneficial effects were consistent across a range of ages and mental states. Conclusions-Both hospital and patient benefited when postoperative rehabilitation was provided in a setting specializing in such care for elderly patients with trauma.