An inpatient rehabilitation model of care targeting patients with cognitive impairment
1 Department of Research, Toronto Rehabilitation Institute, E.W. Bickle Centre for Continuing Care, 130 Dunn Avenue, Toronto, ON, M6K 2R7, Canada
2 L. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
3 Toronto Western Research Institute, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
4 MSK Rehabilitation Program, Toronto Rehabilitation Institute, Hillcrest Centre, 47 Austin Terrace, Toronto, ON, M5R 1Y8, Canada
5 Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
6 Department of Medicine, Baycrest Geriatric Health Care Centre, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
7 Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
BMC Geriatrics 2012, 12:21 doi:10.1186/1471-2318-12-21Published: 25 May 2012
The course and outcomes of hip fracture patients are often complicated by the presence of dementia and delirium, referred to as cognitive impairment (CI), which limits access to in-patient rehabilitation. In response to this concern, members of our team developed and piloted an in-patient rehabilitation model of care (Patient-Centred Rehabilitation Model; PCRM) targeting patients with hip fracture and CI (PCRM-CI). We are now conducting a 3-year study comparing an inpatient rehabilitation model of care for community dwelling individuals with hip fracture and CI (PCRM-CI) to usual care to determine whether it results in improved mobility at the time of discharge from inpatient rehabilitation.
A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usual care. All community dwelling (private home or retirement home) patients following a hip fracture are eligible to participate. Recruitment of both cohorts is taking place at two facilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients in the usual care cohort. We are also recruiting 70 health care providers (HCPs), who are being trained to implement the PCRM-CI, and their unit managers. Patient data are collected at baseline, discharge, and 6 months post-discharge from an inpatient rehabilitation program. Evaluations include mobility, physical function, and living arrangement. Additional outcome variables are being collected from medical records and from the patients via their proxies. Data on the prevalence and severity of dementia and delirium are being collected. Staff data are collected at baseline and one year after implementation of the model to determine change in staff knowledge and attitudes toward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unit managers have been conducted to examine factors and barriers influencing the model implementation. Data collection began in 2009 and is expected to be completed in 2012. The control cohort of 70 patients has been recruited, and 45 patients have been accrued to the intervention group to date.
Evaluation of this model of care is timely given the increasing proportion of persons with cognitive impairment and hip fractures.
The study is registered at