Allied health assistant management of people with hip fracture is feasible and may improve patient adherence to hip fracture mobilisation guidelines: a feasibility randomised controlled trial

Objectives: Determine the feasibility of allied health assistant (AHA) management of people with hip fracture an acute hospital. Design: Assessor-blind, parallel, feasibility randomised controlled trial with qualitative component. Setting: Acute orthopaedic ward. Participants: People with surgically-managed hip fracture, who walked independently pre-fracture and had no cognitive impairment. Interventions: Rehabilitation from an AHA, under the supervision of a physiotherapist, compared with rehabilitation from a physiotherapist. Main outcome measures: Feasibility was evaluated according to focus areas of demand, acceptability, practicality and implementation. Secondary outcomes included estimates of effect of adherence to hip fracture mobilisation guidelines, discharge destination, 30-day readmission, functional activity, and length of stay. Results: Fifty people were allocated to receive rehabilitation from an AHA (n = 25) or physiotherapist (n = 25). AHA rehabilitation had high demand with 60% of eligible participants recruited. Satisfaction with AHA rehabilitation was comparable with physiotherapy rehabilitation (acceptability). The AHA group received an average of 11 min (95% CI 4 to 19) more therapy per day than the physiotherapy group (implementation). The AHA group may have had lower cost of acute care (MD -$3 808 95% CI −7 651 to 35) and adverse events were comparable between groups (practicality). The AHA group may have been 22% (HR 1.22, 95% CI 0.92 to 1.61) more likely to walk on any day and may have had a shorter length of stay (MD −0.8 days, 95% CI −2.3 to 0.7). Conclusions: AHA management of patients with hip fracture was feasible and may improve adherence to mobilisation guidelines and reduce cost of care and length of stay. Clinical Trial Registration Number: ACTRN12620000877987. Contribution of the paper: • It is feasible for allied health assistants, under the supervision of a physiotherapist, to manage the acute care of people with hip fracture who walked independently pre-fracture and had no cognitive impairment. • Delegating acute management of people with hip fracture to allied health assistants may improve adherence to hip fracture mobilisation guidelines and reduce length of stay and cost of acute care, however, further trials are needed to confirm these effects.