Work

Conjoint effect of post-discharge physical exercise and co-managed care on health outcomes of older patients with hip fracture in China: A post-hoc factorial analysis

Year: 2024

Type: article

Abstract: • A factorial analysis was conducted to evaluate the effects of a conjoint intervention with co-managed care in hospitals and post-discharge physical exercise in communities for hip fracture care. • This bundle intervention was more beneficial to reduction of one-year mortality, compared to one single intervention. • The bundle intervention significantly improved walking ability at one-year after patients’ admission and quality of life at four-month after patients’ admission. • The in-hospital co-managed care, combined with community-based physical exercise, is an effective solution for quality improvement of hip fracture care. The study aimed to explore the effects of post-discharge physical exercise combined with co-managed care on health the outcomes of older patients with hip fracture. Based on a completed non-randomised controlled trial which evaluated a co-managed care of patients aged 65 years and above with hip fracture, provided by orthopedists and geriatricians within an acute setting, a retrospective post-hoc factorial analysis was further conducted. The analysis observed the health outcomes of older patients with post-discharge physical exercise combined with co-managed care within hospitals compared to those had either post-discharge physical exercise or co-managed care. The collected data included demographics, clinical characteristics, and follow-up information about post-discharge physical exercises and health outcomes at one-month, four-month, and one-year after admission. The health outcomes comprised the cumulative mortality, complications, ambulatory ability (Fracture Mobility Score), and quality of life (the five-level EuroQol five-dimensional questionnaire) at each follow-up visit. Patients who having the conjoint interventions benefited more reduction of one-year mortality (RR 0.59, 95 %CI: 0.38, 0.80) but no reduction of complications (RR 0.70, 95 %CI: 0.43, 1.14) than each single intervention. Ambulance ability (at one-year follow-up) and quality of life (at four-month follow-up) of patients who having the conjoint interventions were observed a significant improvement against each single intervention. The conjoint intervention with co-managed care and post-discharge physical exercise might contribute more to the quality improvement of hip fracture care in a long run.

Source: Geriatric Nursing

DOI: 10.1016/j.gerinurse.2024.10.058