A single postdischarge telephone call by an occupational therapist does not reduce the risk of falling in women after hip fracture: a randomized controlled trial.

BACKGROUND: Post-discharge telephone calls to reinforce targeted recommendations for fall prevention have scarcely been investigated in hip-fracture survivors. AIM: To assess the effectiveness of a single telephone call by an occupational therapist in reducing the proportion of fallers (primary endpoint) and improving the adherence to targeted recommendations for fall prevention (secondary endpoint) after hospital discharge in hip-fracture women. DESIGN: Randomized controlled trial. SETTING: Post-acute rehabilitation hospital and community (post-discharge). POPULATION: We randomized 169 of 228 women with a fall-related fracture of the hip. Data for analyses were available for 153 women (78 from the intervention group and 75 controls). METHODS: All the women underwent a multidisciplinary program targeted at fall prevention during post-acute inpatient rehabilitation. Additionally, the intervention group received a telephone call by an occupational therapist to reinforce the targeted recommendations for fall prevention at a median of 18 days after discharge. The outcomes were assessed at a six-month follow-up. RESULTS: Eleven of the 78 women (14.1%) from the intervention group, and 10 of the 75 (13.3%) from the controls sustained at least one fall during the follow-up (relative risk=1.06; 95% CI from 0.48 to 2.34). The mean adherence to the recommendations for fall prevention was 75.1% in the intervention group and 71.2% in the controls (between group difference 3.9; 95% CI from -3.4 to 11.3; P=0.29). CONCLUSION: Our study does not support a post-discharge telephone call to reinforce the recommendations for fall prevention in hip-fracture women. CLINICAL REHABILITATION IMPACT: We contribute to elucidate one aspect of multidisciplinary fall-prevention strategies in hip-fracture survivors.

Adherence to recommendations for fall prevention significantly affects the risk of falling after hip fracture: post-hoc analyses of a quasi-randomized controlled trial.

BACKGROUND: Few studies focused on fall prevention in hip-fracture survivors. AIM: To investigate the role of adherence to targeted recommendations on both home environment and behaviors in affecting the hazard of falling after a fall-related hip fracture. DESIGN: Post-hoc analysis of a quasi-randomized controlled trial. SETTING: Post-acute rehabilitation hospital. POPULATION: Ninety-five of 119 women living in the community with a fall-related fracture of the hip. METHODS: We assessed home hazard of falling and suggested targeted modifications of home environment and behaviors in activities of daily living to prevent falls during inpatient rehabilitation. Falls were recorded at a six-month follow-up during a pre-planned home visit. RESULTS: Nineteen of the 95 women sustained at least one fall during the six-month follow-up. Women with > 2 uncorrected risk factors had a significantly higher risk of falling than those with 0-2 risk factors; the odds ratio adjusted for four confounders was 4.58 (95%CI 1.472-4.250; P=0.009). Adherence to recommendations for fall prevention was negatively associated with fall risk. The adjusted odds ratio for a ten percent increase in adherence rate was 0.749 (95%CI 0.594-0.945; P=0.015). CONCLUSION: Uncorrected environmental and behavioral risk factors and poor adherence to targeted recommendations for fall prevention significantly predicted the risk of falling in community-dwelling women who sustained a fall-related hip fracture. CLINICAL REHABILITATION IMPACT: Fall-risk assessment should be performed during inpatient rehabilitation following a fall-related hip fracture. Improving adherence to targeted recommendations emerges as a major goal to prevent falls in hip-fracture survivors.