Smart care for older persons recovering from hip-fracture surgery

Background: Our prior studies found that an interdisciplinary care model including in-home rehabilitation improves outcomes for older persons recovering from hip-fracture surgery (hip-fractured patients). However, we also found that these patients’ family caregivers are greatly burdened by constantly supervising patients to prevent subsequent falls. At the same time, patients’ recovery is negatively affected by poor adherence to in-home rehabilitation due to lack of timely feedback. To address these issues, this clinical trial aims to develop and examine an innovative remote-care model using smart clothing (Smart Care Model) to enhance caregiver competence in detecting fall risk and to allow geriatric nurses to provide instant feedback that enhances adherence to in-home rehabilitation, thus improving hip-fractured patients’ postoperative recovery. This study is innovative in two aspects: (1) it uses remotely monitored smart clothing to facilitate fall prevention and enhance in-home rehabilitation adherence in hip-fractured older persons after hospital discharge, and (2) it uses mixed methods to assess the feasibility of the Smart Care Model and its effects on health outcomes and caregiver burden. Since the Smart Care Model is a practical strategy for subacute and longterm care, and the interdisciplinary intervention is designed to facilitate implementation of coordinated care, thus improving care quality and reducing health care costs, our proposal fits the category of “Health Policy and Social Welfare.” Purpose: The proposed study aims to examine the costs and effects of a Smart Care Model using smart clothing with alarm sensors that detect fall risks and monitor/give feedback on continuously recorded daily activity levels. Method: This mixed-method study will include a quantitative component (a randomized control trial) and a qualitative component. Data will be collected and analyzed using an embedded type of mixed method, i.e., a small qualitative component will be embedded in a larger quantitative study. Before the study, we will seek institutional review board approval. The quantitative component, a randomized experimental design, will examine the effectiveness of the Smart Care Model. The control group will receive only usual care, and the experimental group will receive Smart Care. Subjects will be recruited from the trauma wards of Chang Gung Memorial Hospital (CGMH) at Linkou and Tucheng if they meet these inclusion criteria: (1) ≥60 years old, (2) admitted to the emergency department of CGMH due to one-side hip fracture, (3) received hip arthroplasty or internal fixation, (4) can perform full range-ofmotion (ROM) exercises against gravity and against some or full resistance, and pre-fracture Chinese Barthel Index score> 70, and (5) living in northern Taiwan. The sample will include 158 subjects, with 79 in each group. Patients and caregivers in both groups will be assessed 8 times: at admission, before discharge, 1, 3, 6, 12, 18, and 24 months following hospital discharge. Outcomes will include (a) patient outcomes (clinical outcomes, self-care ability, adherence, service utilization, health-related quality of life [HRQoL] and cost of care), and (b) family caregiver outcomes (preparedness, perceived balance between competing needs, depressive symptoms and HRQoL). Analyses will follow an intention-to-treat principle. The effects of the Smart Care Model on health outcomes will be analyzed by hierarchical linear models. The qualitative component will follow the collection of quantitative data. A subset of 10 patients and their family caregivers will be chosen from participants who receive Smart Care, and 10 who receive routine care for in-depth personal interviews consisting of open-ended questions. Interviews will be transcribed verbatim and analyzed as suggested by Miles and Huberman (1994). After both quantitative and qualitative data are collected, the quantitative and qualitative results will be integrated, compared, and contrasted to fully explore the study aims.

Project ID:PG11101-0073
External Project ID:NHRI-EX111-10906PI