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Kimmel LA, Raper E, Harris IA, Ackerman IN, Page R, Naylor JM, Burge AT, Hepworth G, Harris A, Woode ME, Gabbe BJ, Ekegren CL, Holland AE. HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER): a protocol for a randomised controlled trial. BMJ Open 2024; 14:e079846. [PMID: 38238172 PMCID: PMC10806657 DOI: 10.1136/bmjopen-2023-079846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Hip fractures result in substantial health impacts for patients and costs to health systems. Many patients require prolonged hospital stays and up to 60% do not regain their prefracture level of mobility within 1 year. Physical rehabilitation plays a key role in regaining physical function and independence; however, there are no recommendations regarding the optimal intensity. This study aims to compare the clinical efficacy and cost-effectiveness of early intensive in-hospital physiotherapy compared with usual care in patients who have had surgery following a hip fracture. METHODS AND ANALYSIS This two-arm randomised, controlled, assessor-blinded trial will recruit 620 participants who have had surgery following a hip fracture from eight hospitals. Participants will be randomised 1:1 to receive usual care (physiotherapy according to usual practice at the site) or intensive physiotherapy in the hospital over the first 7 days following surgery (two additional sessions per day, one delivered by a physiotherapist and the other by an allied health assistant). The primary outcome is the total hospital length of stay, measured from the date of hospital admission to the date of hospital discharge, including both acute and subacute hospital days. Secondary outcomes are functional mobility, health-related quality of life, concerns about falling, discharge destination, proportion of patients remaining in hospital at 30 days, return to preadmission mobility and residence at 120 days and adverse events. Twelve months of follow-up will capture data on healthcare utilisation. A cost-effectiveness evaluation will be undertaken, and a process evaluation will document barriers and facilitators to implementation. ETHICS AND DISSEMINATION The Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients and carers. TRIAL REGISTRATION NUMBER ACTRN12622001442796.
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Affiliation(s)
- Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eleanor Raper
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Richard Page
- School of Medicine, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Orthopaedics, Barwon Health, Geelong, Victoria, Australia
- St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Angela T Burge
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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Camilo Ferreira R, Moorhead SA, Zuchatti BV, Correia MDL, Montanari FL, Duran ECM. Nursing interventions and activities for patients with multiple traumas: An integrative review. Int J Nurs Knowl 2023; 34:254-275. [PMID: 36269059 DOI: 10.1111/2047-3095.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify nursing interventions and activities for patients with multiple traumas who have variations in physical mobility. METHODS We used integrative literature review following Whittemore and Knafl method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' guidelines and adopting the Oxford Center for Evidence-Based Classification Medicine - Levels of Evidence. The data collection was carried out between October and December 2019 and updated in May 2022, in the following databases: Virtual Health Library, Cochrane Library, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, PubMed®, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. FINDINGS There were 103 articles to be fully read and evaluated. From these, 34 publications were selected. Most nursing interventions and activities identified were placed in the NIC class Activity and Exercise Management in the Physiological: Basic domain, which has interventions to organize or to assist with physical activity, energy conservation, and expenditure; followed by Elimination Management (interventions to establish and maintain regular bowel and urinary elimination patterns and manage complications due to altered patterns); Immobility Management (interventions to manage restricted body movement and the sequelae); Nutrition Support (interventions to modify or maintain nutritional status); Physical Comfort Promotion (interventions to promote comfort using physical techniques); and Self-Care Facilitation (interventions to provide or assist with routine activities of daily living). CONCLUSIONS The interventions and nursing activities found in this research were not only related to the change in mobility in victims of multiple traumas but also aimed to prevent the consequences of immobility and to take care of already established conditions. IMPLICATIONS FOR THE NURSING PRACTICE This research enables the taxonomy's development and the validation of interventions for selected groups of patients. This allows the contribution to the development of the NIC-an important resource to improve nursing practice in teaching, research, and care.
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Affiliation(s)
| | - Sue Ann Moorhead
- Emeritus professor and past Director for the Center for Nursing Classification & Clinical Effectiveness, College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Fabio Luis Montanari
- Specialist in oncology nursing, Master Student at Program at School of Nursing, State University of Campinas and Jaguariúna University Center - UniFAJ, Campinas, Brazil
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Gohy B, Opava CH, von Schreeb J, Van den Bergh R, Brus A, El Hamid Qaradaya A, Mafuko JM, Al-Abbasi O, Cherestal S, Fernandes L, Da Silva Frois A, Weerts E, Brodin N. Monitoring independence in daily life activities after trauma in humanitarian settings: Item reduction and assessment of content validity of the Activity Independence Measure-Trauma (AIM-T). PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001334. [PMID: 36962914 PMCID: PMC10021394 DOI: 10.1371/journal.pgph.0001334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
A standardized set of measures to assess functioning after trauma in humanitarian settings has been called for. The Activity Independence Measure for Trauma (AIM-T) is a clinician-rated measure of independence in 20 daily activities among patients after trauma. Designed in Afghanistan, it has since been used in other contexts. Before recommending the AIM-T for wider use, its measurement properties required confirmation. This study aims at item reduction followed by content validity assessment of the AIM-T. Using a two-step revision process, first, routinely collected data from 635 patients at five facilities managing patients after trauma in Haiti, Burundi, Yemen, and Iraq were used for item reduction. This was performed by analyzing inter-item redundancy and distribution of the first version of the AIM-T (AIM-T1) item scores, resulting in a shortened version (AIM-T2). Second, content validity of the AIM-T2 was assessed by item content validity indices (I-CVI, 0-1) based on structured interviews with 23 health care professionals and 60 patients in Haiti, Burundi, and Iraq. Through the analyses, nine pairs of redundant items (r≥0.90) were identified in the AIM-T1, leading to the removal of nine items, and resulting in AIM-T2. All remaining items were judged highly relevant, appropriate, clear, feasible and representative by most of participants (I-CVI>0.5). Ten items with I-CVI 0.5-0.85 were revised to improve their cultural relevance or appropriateness and one item was added, resulting in the AIM-T3. In conclusion, the proposed 12-item AIM-T3 is overall relevant, clear, and representative of independence in daily activity after trauma and it includes items appropriate and feasible to be observed by clinicians across different humanitarian settings. While some additional measurement properties remain to be evaluated, the present version already has the potential to serve as a routine measure to assess patients after trauma in humanitarian settings.
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Affiliation(s)
- Bérangère Gohy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Humanity & Inclusion, Rehabilitation technical direction, Brussels, Belgium
| | - Christina H. Opava
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Aude Brus
- Impact & Information Division, Humanity & Inclusion, Innovation, Brussels, Belgium
| | | | - Jean-Marie Mafuko
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
| | - Omar Al-Abbasi
- Médecins Sans Frontières, Operational Center Brussels, Erbil, Iraq
| | - Sophia Cherestal
- Médecins Sans Frontières, Operational Center Brussels, Port-au-Prince, Haiti
| | - Livia Fernandes
- Médecins Sans Frontières, Operational Center Paris, Baghdad, Iraq
| | | | - Eric Weerts
- Humanity & Inclusion, Rehabilitation technical direction, Brussels, Belgium
| | - The AIM-T Study Group
- Médecins Sans Frontières, Operational Center Brussels, Brussels, Belgium
- Médecins Sans Frontières, Operational Center Paris, Gaza, Palestinian territories
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
- Médecins Sans Frontières, Operational Center Brussels, Port-au-Prince, Haiti
- Médecins Sans Frontières, Operational Center Paris, Baghdad, Iraq
- Médecins Sans Frontières, Operational Center Paris, Paris, France
- Médecins Sans Frontières, Operational Center Paris, Aden, Yemen
- Humanity & Inclusion, Bujumbura, Burundi
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, Department of Orthopaedics, Danderyd Hospital Corp., Danderyd, Sweden
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Bridger K, Kellezi B, Kendrick D, Radford K, Timmons S, Rennoldson M, Jones T, Kettlewell J. Patient Perspectives on Key Outcomes for Vocational Rehabilitation Interventions Following Traumatic Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042035. [PMID: 33669750 PMCID: PMC7922329 DOI: 10.3390/ijerph18042035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 01/17/2023]
Abstract
Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to survivors. Trauma survivors (n = 17) participated in in-depth semi-structured interviews or focus groups exploring outcomes that were important to them for recovery and return to work. Data were analysed using thematic analysis. Participants identified a range of outcomes that they considered important and necessary to facilitate a successful and sustainable return to work: physical and psychological recovery, purposeful life engagement, managing expectations of recovery, managing expectations about return to work, and employers’ expectations. Our participants advocated for a multifaceted and biopsychosocial understanding of recovery and outcomes that need to be captured for vocational rehabilitation interventions. Implications for practice and research are discussed, and recommendations are given based on the findings.
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Affiliation(s)
- Kay Bridger
- Department of Psychology, Nottingham Trent University, Nottingham NG1 4FQ, UK; (K.B.); (M.R.)
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (D.K.); (K.R.); (T.J.); (J.K.)
| | - Blerina Kellezi
- Department of Psychology, Nottingham Trent University, Nottingham NG1 4FQ, UK; (K.B.); (M.R.)
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (D.K.); (K.R.); (T.J.); (J.K.)
- Correspondence:
| | - Denise Kendrick
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (D.K.); (K.R.); (T.J.); (J.K.)
| | - Kate Radford
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (D.K.); (K.R.); (T.J.); (J.K.)
| | - Stephen Timmons
- Business School, University of Nottingham, Nottingham NG8 1BB, UK;
| | - Mike Rennoldson
- Department of Psychology, Nottingham Trent University, Nottingham NG1 4FQ, UK; (K.B.); (M.R.)
| | - Trevor Jones
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (D.K.); (K.R.); (T.J.); (J.K.)
| | - Jade Kettlewell
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (D.K.); (K.R.); (T.J.); (J.K.)
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