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An Inpatient Rehabilitation Model of Care Targeting Patients With Cognitive Impairment

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01566136
Recruitment Status : Completed
First Posted : March 29, 2012
Last Update Posted : April 24, 2014
Information provided by (Responsible Party):
University Health Network, Toronto

Brief Summary:
Hip fractures are a danger to an individual's mobility, independence and ability to live in the community. When patients have a cognitive impairment (such as dementia or delirium) they do not recover as well or go back to their homes as often as those patients who do not have a cognitive impairment. Therefore, our team developed a rehabilitation model to care for patients with hip fractures, and specifically for those patients with CI. The model of care is called the Patient Centred Rehabilitation Model of Care (PCRM-CI). This 3 year study will focus on comparing the new model with usual rehabilitation care. This study will also focus on understanding the factors that could influence the use of the model on new rehabilitation units. The investigators hypothesize that patients who have received the new model of care will have better mobility outcomes over time. The investigators will collect data in 2 hospitals, 70 patients receiving the usual care and 70 patients receiving the care in the new model. The team will invite 60 staff and their unit managers as well. This study will help decision makers to use research findings to make better decisions about care of older Canadians.

Condition or disease Intervention/treatment Phase
Hip Fracture Behavioral: Rehabilitation Model of Care Phase 2 Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 198 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: An Inpatient Rehabilitation Model of Care Targeting Patients With Cognitive
Study Start Date : August 2009
Actual Primary Completion Date : March 2014
Actual Study Completion Date : March 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
No Intervention: Usual care
Current routine rehab care for persons with a hip fracture and CI lacks a well integrated care system within the local hospital network. The usual approach to care at the two sites differ in one major way: patients presenting with a hip fracture to Site 1 receive surgery locally, while those presenting to Site 2 receive surgery at a different hospital because of the absence of an operating suite at this site. Within 2 to 10 days 95% of patients presenting to either site hospital's emergency room with a hip fracture, receive internal fixation or arthroplasty surgery. Patients, including some with mild and moderate CI, are then transferred to in-patient rehabilitation beds at Site 1 or Site 2. Screening of patients for dementia or delirium is not routinely done.
Experimental: Rehabilitation Model of Care
Staff will be introduced to five components of the Patient-Centred Rehabilitation Model of Care (PCRM-CI) in a one-day workshop prior to implementing the PCRM-CI model. They will then be provided with eight additional educational sessions throughout the year. A manual detailing all aspects of training, including specifics on how to present the material, ideas for stimulating discussion, and case vignettes to illustrate training concepts was developed for our pilot study and will be used here. We also produced a short video on care of elderly with CI in rehabilitation which will be utilized in the training session. The model will be tested over a one year period with a sustainability plan in place developed by the local hospital network and the two study sites.
Behavioral: Rehabilitation Model of Care
The PCRM-CI model includes the following 5 components: rehabilitation management; dementia management; delirium prevention and management; staff education and support; and family/significant other support and education.
Other Name: Patient Centred Rehabilitation Model of Care

Primary Outcome Measures :
  1. Change from baseline in mobility at 6 months [ Time Frame: Baseline to 6 months post-surgery ]

Secondary Outcome Measures :
  1. Change from baseline in physical functioning at 6 months [ Time Frame: Baseline to 6 months post-surgery ]

Information from the National Library of Medicine

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Ages Eligible for Study:   65 Years and older   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 65 years or older,
  • admitted to rehabilitation directly from an acute care hospital after receiving surgery for a hip fracture
  • living in the community, home or residential setting (where an individual has services and supports but does not require 24 hour nursing care) prior to sustaining the hip fracture,
  • able to speak and understand English
  • have a family member or close friend who is familiar with the patients' pre-fracture condition and can act as a collateral informant.

Exclusion Criteria:

  • they have a pathologic hip fracture
  • the hip fracture is associated with multiple trauma
  • they have had a previous hip fracture.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01566136

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Canada, Ontario
Northumberland Hospital
Cobourg, Ontario, Canada
Sponsors and Collaborators
University Health Network, Toronto
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Principal Investigator: Katherine S McGilton, PhD UHN-Toronto Rehab
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: University Health Network, Toronto Identifier: NCT01566136    
Other Study ID Numbers: CIHR DPA-93049
First Posted: March 29, 2012    Key Record Dates
Last Update Posted: April 24, 2014
Last Verified: April 2014
Keywords provided by University Health Network, Toronto:
hip fracture patients
cognitive impairment
rehabilitation model of care
Additional relevant MeSH terms:
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Hip Fractures
Fractures, Bone
Wounds and Injuries
Femoral Fractures
Hip Injuries
Leg Injuries