Parallel group randomized controlled equivalence trial; MHR versus inpatient rehabilitation
(i) (40 in the MHR group and 41 in the inpatient group); (ii) Location—Hong Kong; (iii) Inclusion/exclusion criteria specified—partially; (iv) Age (y)— for both groups; (v) Sex—49 females (60%) and 32 males (40%); (vi) Duration since hip fracture or surgery—not reported; (vii) Comorbidities reported—no
MHR group (i) No description provided for the nature of exercises. (ii) Average of PT visits and average of community nurse visits. Inpatient group (i) No description provided for the nature of exercises. (ii) Average stay in rehabilitation hospital was days with daily PT visits.
PRO None used PBO Ambulatory capacity Measured across five categories: community ambulatory, house-hold ambulatory, walking on flat surface, transfer from bed to chair, bed to chair bound. (scoring: 4 = independent without aids, 3 = independent with aids, 2 = able to walk with minimum assistance/supervision, 1 = able to walk with maximum assistance, 0 = unable to walk)
(i) Lost to followup was 9 in the MHR group and 16 in the inpatient group. Causes of attrition were not provided. (ii) Adverse events not reported. (iii) Community ambulatory ability was better in the MHR group. Flat-level ambulatory ability was similar in both the groups.
Parallel group randomized controlled equivalence trial; MHR versus NT
(i) (34 in the MHR group and 32 in the NT group; (ii) Location—Australia; (iii) Inclusion/exclusion criteria specified—yes; (iv) Age (y)—median 81.6 (IQR: 78.2, 85.4) in the MHR group and median 83.5 (IQR: 76.6–85.5) in the NT group; (v) Sex—21 females (62%) in the MHR group and 24 females (75%) in NT group; (vi) Average duration since surgery—not reported; (vii) Comorbidities reported—no
MHR group (i) Home visit to organize modifications and install equipment prior to discharge. (ii) Visited by therapists (team coordinator, PT, OT, SLP, SW, and therapy aid) within 48 hours of discharge. (iii) Frequency of therapy was tailored for individualized needs. Structured practice sessions encouraged between visits. (iv) Services such as podiatry, nursing care and assistance with light domestic tasks were provided as required. NT group: Received routine hospital care: inpatient services and the development of care pathways and discharge planning.
PRO Balance Confidence ABC Scale Functional Status (i) MBI (ii) LHS HRQOL (i) LHS (ii) SF-36 (PCS and MCS) PBO Balance BBS Physical mobility TUG Falls Frequency of falls and falls that requirehospitalization
(i) Attrition or causes of attrition were not specified. (ii) Adverse events were not reported. (iii) Patients in the MHR group did not show improvement in physical health but reported improvement in ADL. (iv) MHR group also had greater confidence in avoiding falls at four months.
Parallel group randomized controlled equivalence trial; MHR versus NT
(i) (48 in MHR group and 54 in NT group); (ii) Location—Sweden; (iii) Inclusion/exclusion criteria specified—yes (iv) Age (y)— in MHR group and in NT group; (v) Sex—29 females (60.4%) in the MHR group and 42 females (77.8%) in the NT group; (vi) Comorbidities reported—yes.
MHR group (i) Three weeks of rehabilitation that included PT to encourage self-efficacy and OT to encourage activity and independence in ADL. (ii) Participants received a mean of 4.9 (±0.4) multiprofessional home visits; 2.4 PT (±1.7) and 1.6 OT (±1.7) visits. (iii) Every fourth patient received a visit by a nurse. NT group No additional treatment after being discharged from hospital.
PRO Balance Confidence Swedish version of the FES (S) Functional Status (i) FIM motor scale (ii) Instrumental Activity Measure (measures degree of independence in eight advanced activities) (iii) Frenchay’s Activity Index (determines the frequency of performing social and complex daily activities) PBO Physical Mobility TUG Lower Extremity Strength STS test
(i) Lost to follow up was 6 in the MHR group; causes of attrition were provided. (ii) No adverse events were reported (iii) The MHR group showed significant improvements on the FES, TUG, STS, FIM, Instrumental Activity Measure, and the Frenchay’s Activity Index one month after discharge compared to the NT group.
Parallel group randomized controlled equivalence trial; MHR versus NT
(i) (48 in the MHR group, 54 in the NT group); (ii) Location—Sweden; (iii) Inclusion/exclusion criteria specified—partially; (iv) Age (y)— in MHR group and in NT group; (v) Sex—29 females (60.4%) in the MHR group and 42 females (77.8%) females in the NT group; (vi) Average duration since surgery—not reported; (vii) Comorbidities reported—yes
MHR group (i) Three weeks of rehabilitation that included PT to encourage self-efficacy and OT to encourage activity and independence in ADL. (ii) Median of visits 4.5 (with median of 3 PT visits and 1.5 OT visits, 11 patients were visited by a nurse). NT group No additional treatment after being discharged from hospital.
PRO Balance Confidence FES(S) Functional Status (i) FIM (ii) Instrumental Activity Measure (iii) Frenchay’s Activity Index HRQOL SF-36 Mood Centre for Epidemiological Studies Depression Scale (screening instrument to measure depressive symptoms) PBO Physical Mobility TUG Lower Extremity Strength STS
(i) One participant in the MHR group and 3 in the NT group were lost at 6-month followup; additional 3 participants in the MHR group and 4 participants in the NT group were lost to followup at 1-year (reasons for attrition were provided). (ii) The MHR group had greater balance confidence and physical function than the NT group over 1 year period after hip fracture. (iii) One year after discharge 29% of the people in the MHR group considered themselves fully recovered, compared to only 9% in the NT group.
Parallel group randomized controlled equivalence trial; MHR versus NT
(i) (not clear about how many in each group); (ii) Location—Australia; (iii) Inclusion/exclusion criteria specified—yes (iv) Age (y) —mean of for both groups combined; (v) Sex—41 (73%) females for both groups combined; (vi) Average duration since surgery—not reported; (vii) Comorbidities reported—no.
MHR group (i) Home visits by PT, OT, SLP, SW, and therapy aides. (ii) Services such as podiatry, nursing care, and assistance with light domestic tasks were provided as required. NT group: Received routine hospital care, inpatient services, development of care pathways, and discharge planning.
PRO Functional Status Modified Barthel Index HRQOL SF-36 (MCS & PCS) PBO Physical Mobility TUG
(i) Ten patients unavailable for 12-month followup (reasons for attrition were provided). (ii) At 12 months, there were no differences between the groups for scores on the MBI, TUG, or SF-36 outcomes (PCS and MCS).
MHR: multidisciplinary home rehabilitation; IQR: interquartile range; NT: no treatment; PT: physiotherapist; OT: occupational therapist; SLP: speech language pathologist; SW: social worker; ADL: activities of daily living; PRO: patient-reported outcome; PBO: performance-based outcomes; ABC: activity-specific balance confidence scale; MBI: Modified Barthel Index; LHS: London Handicap Scale; SF-36: Short-Form-36; PCS: physical component summary; MCS: mental component summary; BBS: Berg balance scale; TUG: timed up and go test; FES: falls efficacy scale; FIM: functional independent measure; STS: sit-to-stand.
