Mon, Feb 13, 2017, noon:
Daniel Almirall, "Getting SMART about adaptive interventions"
Shyu, Y.I., Jersey Liang, C.C. Wu, J.Y. Su, H.S. Cheng, S.W. Chou, M.C. Chen, C.T. Yang, and M.Y. Tseng. 2010. "Two-Year Effects of Interdisciplinary Intervention for Hip Fracture in Older Taiwanese." Journal of the American Geriatrics Society, 58(6): 1081-1089.
OBJECTIVES: To explore the 2-year outcomes of an interdisciplinary intervention for elderly patients with hip fracture. DESIGN: Randomized experimental design. SETTING: A 3,000-bed medical center in northern Taiwan. PARTICIPANTS: Patients with hip fracture (N = 162): 80 in the intervention group and 82 in the usual care control group. INTERVENTION: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. MEASUREMENTS: Outcomes (clinical outcomes, self-care ability, health-related quality of life (HRQoL), service utilization, and depressive symptoms) were assessed 1, 3, 6, 12, 18, and 24 months after discharge. Self-care ability (ability to perform activities of daily living (ADLs)) was measured using the Chinese Barthel Index. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version (SF-36). Depressive symptoms were measured using the Chinese Geriatric Depression Scale, short form. RESULTS: Subjects in the intervention group had significantly better ratios of hip flexion (beta = 5.43, P < .001), better performance on ADLs (beta = 9.22, P < .001), better recovery of walking ability (odds ratio (OR) = 2.23, P < .001), fewer falls (OR = 0.56, P = .03), fewer depressive symptoms (beta = -1.31, P = .005), and better SF-36 physical summary scores (beta = 6.08, P < .001) than the control group during the first 24 months after discharge. The intervention did not affect the peak force of the fractured limb's quadriceps, mortality, service utilization, or SF-36 mental summary score. CONCLUSION: The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes, self-care ability, and physical health-related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge. J Am Geriatr Soc 58: 1081-1089, 2010.
Country of focus: Taiwan.