Hip Fracture Exercise and Rehabilitation Post Hip Fracture Study

Although a small number of interventions have been found to be effective in improving
mobility and functional recovery after a hip fracture, these studies have routinely excluded
patients with cognitive limitations, a group with poor outcomes after hip fracture. It is
estimated that 15-20% of all hip fracture patients experience cognitive limitation following
surgery from previously undetected cognitive impairment, delirium, and other post-operative
complications that persist following hospital discharge and those with cognitive limitations
are slow to recover. Despite potential for a full recovery, many hip fracture patients with
cognitive limitation may be discharged early from rehabilitation settings due to
misperceptions about rehabilitation potential, or other psychological issues that limit their
participation.

The innovation of this study is that it focuses on a critically vulnerable and costly group
of patients (hip fracture patients with cognitive limitations) with an extended intervention
that is tailored to the patient's needs and cognitive abilities. The post-rehabilitation
period after hip fracture has been largely ignored and little is known about the effective
strategies to help transition and maintain hip fracture patients (especially those with
cognitive limitations) in the home setting. HipERS utilizes an effective approach to address
for functional gains, but where limited attention has been given. It focuses on motivational
and behavioral challenges in patients with cognitive limitations and their caregivers, which
has been largely ignored in the hip fracture research

This study will gather information from 5 people with cognitive limitations who fractured a
hip. Caregivers (family relative or non-relative, unpaid or paid, formal or informal) will
also be invited to participate. Hip fracture participants will receive a home-based exercise
intervention that will start after their "normal" rehabilitation is done. The function-based
exercise intervention will be provided by physical therapists 2-3 times a week for 6 weeks.
Additionally, the physical therapist will encourage the caregiver to motivate and actively
engage the hip fracture participant in the therapist-prescribed home exercise program so that
this can be maintained at the end of the 6-week intervention. The feasibility of the
intervention will be based on the percentage of sessions participants complete. The
information we get from this feasibility study will be used to plan a larger study.

Hip Fracture Participant

Inclusion criteria:

- Hip fracture

- Age 65+ at time of fracture

- Had surgical repair for the hip fracture

- Completed usual rehabilitation

- Discharged to the community after rehabilitation ends (i.e., private home or assisted
living)

- Cognitive limitation (MoCA score 18-25)

Exclusion criteria

- Pathologic fracture

- Not community-dwelling (e.g., nursing home resident) prior to fracture

- Bedbound during the 6 months prior to fracture

- Not returning to the community before 180 days post-hospital discharge (can go to
assisted living)

- Not authorized by a physician to participate in an exercise or rehabilitation program
prior to starting the intervention

- Gait speed of greater than 0.8 m/s (already walking well) at baseline

Caregiver Participant

Inclusion criteria:

- Identified as a caregiver (i.e., family relative or non-relative, unpaid or paid,
informal or formal) who will help or supervise the hip fracture participant with ADL
or IADL tasks after discharge from rehab

- Helping or supervising the hip fracture participant with one or more ADL or IADL tasks
at least weekly when screened for this study OR plans to be the primary person
providing care at least weekly after the hip fracture participant is discharged from
rehab

Exclusion criteria:

- Not English speaking

- Living more than 40 miles from the hip fracture participant

- Unable to provide informed consent