Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial.

Background: Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods: In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings: Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation: This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes. Funding: EIT Health and the Ramón y Cajal 2021 Excellence Research Grant action from the Spanish Ministry of Science and Innovation.

An m-Health telerehabilitation and health education program on physical performance in patients with hip fracture and their family caregivers: Study protocol for the ActiveHip+ randomized controlled trial.

Telerehabilitation interventions administered via a smartphone may provide new feasible and effective rehabilitation options at home for patients with hip fracture. However, to date, no such interventions have been shown to be effective in the recovery key health outcomes of these patients. The present multicentre randomized controlled trial (RCT) aims to test the effect of the ActiveHip+ m-Health system in the recovery of physical performance, functional level, quality of life, and other health-related outcomes in both patients with hip fracture and their family caregivers. A total of 104 patients older than 65 years, with hip fracture, and their family caregivers will be randomized into the ActiveHip+ rehabilitation (N = 52) or the control group (N = 52). ActiveHip+ is a 12-week smartphone-based rehabilitation program conducted in Granada and Cádiz (Spain) that includes: (1) 24 sessions of physical exercise and 12 sessions of occupational therapy; (2) seven educational modules for patients and for caregivers; and (3) general recommendations in activities of daily living. The control group will receive the usual rehabilitation protocol offered by the Andalusian Public Healthcare System. The primary outcome is the patient's physical performance, while the secondary outcomes are the patient's functional level, quality of life, pain, fear of falling, fitness perception, pre-fracture functional level, emotional status, and caregiver burden. The present project will substantially contribute to the existing knowledge by testing for the first time the efficacy and feasibility of a multidisciplinary m-Health system in the rehabilitation of patients with hip fracture.

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.

Development and Evaluation of a Post-Hip Fracture Instructional Workshop for Caregivers.

BACKGROUND AND PURPOSE: A hip fracture is an unexpected traumatic event. Caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregivers who perceive a higher level of preoccupation about the care of their family member/friend. The objective of this study was to develop and test feasibility for a post-hip fracture inpatient instructional workshop for caregivers of older adults with hip fracture and to establish their knowledge of hip fracture recovery and perceptions of the utility and satisfaction with the workshop. METHODS: This 2-part study was conducted at the University Hospital of Granada, Spain, from September 2016 to April 2017. We invited caregivers of patients (60 years of age or older) hospitalized for a surgically treated fall-related hip fracture to attend an informational and skill development hospital-based workshop (60-90 minutes in duration) on postdischarge management strategies. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture and their perceived concerns. Furthermore, we requested that they provide feedback on workshop utility and satisfaction (0-10 points) and suggestions for improving the workshop. RESULTS AND DISCUSSION: We delivered 42 workshops over an 8 month period. One hundred three caregivers attended the sessions and enrolled in the study, mean (SD) age: 52.1 (12.8) years. Sixty-nine percent of the caregivers were women. Caregivers' main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1, Q3) of both workshop utility and satisfaction was 10 (10, 10), minimum-maximum: 7 to 10. CONCLUSIONS: Caregivers in this study stated that the workshop was useful and satisfactory. Because caregivers play such a vital role in recovery after hip fracture, providing knowledge and skill development as part of health care delivery may support more person-centered care.

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.

Cirugía percutánea en el neuroma de morton. Revisión de casos / Percutaneos sugery for Morton’s neuroma. Revision of cases

Presentamos los resultados obtenidos en 10 pacientes diagnosticados de neuroma de Morton, sometidos a cirugía percutánea del antepié. El seguimiento medio fue de 13 meses. Se registran de forma retrospectiva los cambios en la percepción del dolor (escala numérica verbal) y la evolución de los datos pre y postoperatorios de la escala AOFAS (American Orthopedic Foot and Ankle Surgery). Mostramos el grado de satisfacción con la técnica empleada y la necesidad de seguir usando plantillas o calzado especial. Nuestros resultados se contrastan con los obtenidos por otros autores con el mismo procedimiento quirúrgico y frente a otras técnicas clásicas y más recientes. Tras esto mantenemos que esta opción terapéutica es fiable, ofreciendo una buena respuesta clínica con escasa morbilidad

We show the results after percutaneous surgical procedure in 10 patients suffering Morton´s disease. Medium follow-up was 13 months. Results in pain perception (numerical verbal pain scale) and pre and postoperative AOFAS (Orthopedic Foot and Ankle Surgery) data were taken retrospectively. Patient´s satisfaction is graded as well as the use of insoles or special shoe wearing. We compared our results to other authors´ experience in same procedure and to classical and newer different techniques. After that we maintain this therapeutic option is reliable and offers good clinical outcome and low morbility

Exótosis subungueal: un verdadero osteocondroma / Subungual exostosis: a true osteochondroma

La deformidad de la uña de los dedos del pie puede ser debida a lesiones óseas subyacentes. En este caso presentamos una lesión ósea subungueal y detallamos su diagnóstico diferencial en una mujer de 15 años cuya uña del tercer dedo del pie izquierdo se muestra sobreelevada y desplazada medialmente por una tumoración infrayacente. Se palpa un nódulo de consistencia dura adherido a la piel, de un centímetro de diámetro, de crecimiento lento en el último año. No refiere dolor. Radiográficamente se presenta como lesión exofítica redondeada y pediculada al extremo de la falange distal similar a un osteocondroma (OC). La anatomía patológica lo confirma. Entre las lesiones óseas benignas el OC es la más frecuente. Postulamos razones clínicas, radiológicas y anatomopatológicas para diferenciarlo de la exóstosis subungueal clásica, de la periostitis reactiva, de la exóstosis de Turret, del pseudotumor fibroso cortical y de la proliferación osteocondromatosa bizarra parostal. Su degeneración maligna no se debe subestimar. El OC subungueal es infrecuente y puede pasar desapercibido largo tiempo o incluso ser derivado a dermatología por sospecha de paroniquia. Su tratamiento es sencillo, pero precisamos la participación del patólogo para su correcto diagnóstico

Ungual deformity in toes may be due to underlying bony lessions. In this case we present a subungual bone lession, giving detail to differential diagnosis, in a 15 years old woman whose third toe nail is pushed up and laterally displaced by a deep tumor. A hard-attached to skin one centimeter diameter slowly growing last year nodule is palpable. No pain is referred. X-ray show an exophytic, rounded, osteochondroma (OC)-like lesion pediculated to falanx tip. Histology confi rms diagnosis. OC is the most common skeletal neoplasm of all benign bone tumors. We postulate clinical, radiological and histological fi ndings to differentiate OC from classical subungual exostosis, reactive periostitis, Turre's exostosis and bizarre parosteal osteochondromatous proliferation. Malignant transformation can't be underestimated. Subungual OC frequency is low, may be long time misdiagnosed and derived to dermatologist suspecting paronychia. Easy to treat, we need pathologist's participation for a correct diagnosis