Effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture.

INTRODUCTION: Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. METHODS: The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients' quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. RESULTS: The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). DISCUSSION: The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.

Effects of Tele-Rehabilitation Compared with Home-Based in-Person Rehabilitation for Older Adult's Function after Hip Fracture.

This study aimed to examine the effect of a multidisciplinary tele-rehabilitation program on functional recovery of older adults with hip fracture compared with home-based in-person rehabilitation. In this single-blinded, non-randomized clinical trial, we included older with hip fracture. The tele-rehabilitation group received a 12-week tele-rehabilitation program (supervised by their family caregivers). The control group received the usual postoperative rehabilitation provided by the Andalusian health system (Spain). The primary outcome was the patient-reported functional status assessed with the Functional Independence Measure. We also measured performance-based functional recovery using the Timed Up and Go Test and Short Physical Performance Battery. We performed both a per-protocol (62 participants; 28 tele-rehabilitation and 34 control groups) and an intention-to-treat analysis (71 participants; 35 tele-rehabilitation and 36 control groups). Participants who used the tele-rehabilitation program had higher Functional Independence Measure scores (high effect size: 0.98 Cohen's d; p < 0.001) and better performance in the Timed Up and Go Test (medium effect size: 0.63 Cohen's d; p = 0.025) compared with the control group. Differences between groups post-intervention were not statistically significant in the Short Physical Performance Battery. The tele-rehabilitation intervention proposed in this study is a valuable treatment option in the recovery process for older adults with hip fracture. ClinicalTrials.gov Identifier: NCT02968589.

A home-based tele-rehabilitation protocol for patients with hip fracture called @ctivehip.

Home-based tele-rehabilitation programs are under development and may be a future option for some patients. The objectives of this non-randomized clinical trial are to design a home-based multidisciplinary tele-rehabilitation protocol for patients with hip fracture, and to compare this protocol versus the home-based usual outpatient rehabilitation protocol. Seventy patients treated for an acute hip fracture, aged 65 years or older, with a high pre-fracture functional level (Functional Independence Measure score >90), without severe cognitive impairment, absence of terminal disease, discharged to their own home or a relativés home postoperatively, allowed weight-bearing, and with signed informed consent, will be allocated into a tele-rehabilitation group (n = 35) or a control group (n = 35). The inclusion criterion for the intervention group will be to have a caregiver with the ability to access the Internet who is willing to perform exercises and activities with the patient at home. The intervention includes a program of physical exercise and occupational therapy (five weekly sessions during 12 weeks), and recommendations for patients and their caregivers, all delivered through a website. The patient's functional level (Functional Independence Measure), quality of life (Euro-Qol), physical performance (Timed Up and Go), caregiver burden (Zarit Interview), and other descriptive data will be assessed at hospital discharge, 4 weeks, and 12 weeks. This project will add to the knowledge concerning the feasibility of tele-rehabilitation as an option to promote recovery of the pre-fracture functional level for some patients with a hip fracture. ClinicalTrials.gov Identifier: NCT02968589NCT.

The Threshold Distance Associated With Walking From Home to School.

Active commuting to school has health implications among young people. We aimed to (a) examine the patterns of commuting to school in children and adolescents regarding gender and area of residence, (b) study the association between distance from home to school and mode of commuting, and (c) identify the threshold distance below which young people are more likely to walk to school. A total of 6,004 students aged 7 to 18 years from Spain participated in this study. Mode of commuting was self-reported and distance was objectively measured using Google Maps software. Associations were examined using binary logistic regression and receiver operating characteristic curves analysis. Around 67% of children and 60% of adolescents commuted to school actively (mainly walking). The threshold distance for walking to school was 875 m, 0.54 miles, in children, and it was higher among urban (1,250 m, 0.78 miles) than in rural participants (675 m, 0.42 miles). The threshold distance for walking to school was 1,350 m, 0.84 miles, in adolescents, and it was lower among urban (1,350 m, 0.84 miles) than in rural participants (1,550 m, 0.96 miles). Future interventions on active commuting to school should consider this threshold distance, and chances of promoting an active commuting to school could have as a goal the increase of this threshold distance.