ABSTRACT
BACKGROUND: Early mobilization after surgery is a key recommendation for people with hip fracture, however this is achieved by only 50% of people. Recumbent bike riding has been used in other populations with limited mobility and has potential to allow early exercise in people post hip fracture. The primary aim of this pilot trial was to demonstrate the feasibility of a trial protocol designed to determine the effect of early post-operative cycling in bed on outcomes in people with hip fracture. METHODS: Single-blinded, multi-site randomized controlled pilot trial. Fifty-one people with hip fracture were recruited within 4 days of surgery from two sites in Victoria. Participants were randomly allocated to receive either usual care (n = 25) or usual care plus active cycling in bed (n = 26). The cycling intervention was delivered on weekdays until the participant could walk 15 m with assistance of one person. The primary outcomes were trial feasibility and safety. Clinical outcomes, including mobility (Modified Iowa Level of Assistance Scale) and delirium were measured at day seven post-operatively and at hospital discharge by an assessor blinded to group. Additional outcomes at discharge included gait speed, cognition and quality of life. RESULTS: The intervention was safe, feasible and acceptable to patients and staff. Delivery of the intervention was ceased on (median) day 9.5 (IQR 7, 12); 73% of scheduled sessions were delivered; (median) 4 sessions (IQR 2.0, 5.5) were delivered per participant with (median) 9 min 34 s (IQR 04:39, 17:34) of active cycling per session. The trial protocol was feasible, however at day seven 75% of participants had not met the criterion (able to walk 15 m with assistance of one person) to cease the cycling intervention.. CONCLUSION: In bed cycling is feasible post-operatively following hip fracture, however seven days post-operatively is too early to evaluate the impact of the cycling intervention as many participants were still receiving the intervention. A fully powered RCT to explore the effectiveness and cost efficiency of this novel intervention is warranted. TRIAL REGISTRATION: The trial was prospectively registered (25/09/2017) with the Australian New Zealand Clinical Trials Registry ACTR N12617001345370 .
Subject(s)
Hip Fractures , Quality of Life , Australia , Feasibility Studies , Hip Fractures/surgery , Humans , WalkingABSTRACT
OBJECTIVE: To determine the prevalence of illicit substance use among patients presenting to one ED with acute behavioural disturbance using point-of-care saliva testing. METHODS: A prospective observational study was conducted. Acute behavioural disturbance was defined as any episode requiring a security response for unarmed threat (Code Grey). The setting was a single ED and tertiary referral centre located in metropolitan Australia. Participants were adults presenting to the ED requiring a Code Grey. Saliva was analysed for meth/amphetamine, cannabis, cocaine and opiates using a rapid point-of-care test. Self-reported drug use was recorded at the time of saliva testing. Data collection occurred between August 2016 and March 2017. RESULTS: There were 229 valid saliva samples. Participants were, on average, 35 years (range 18-72) and male (168/229; 73%). Forty percent (95% confidence interval 34-47) of samples tested positive, with 20% positive for two or more substances. Meth/amphetamines was detected in 92% of positive samples, 17% of samples tested positive for opiates, 8% for cannabis and 7% for cocaine. Among participants, 19% self-reported current substance use and 20% reported using illicit substances within the past 24 h. CONCLUSIONS: The prevalence of illicit substance use among this cohort was 40%. Self-reporting was unreliable. Point-of-care saliva testing is feasible. Early identification of harmful drug use may assist clinical decision making in selected or undifferentiated cases and provide an opportunity to implement harm minimisation strategies and make referrals.
