This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals.Aims
Methods
Operative treatment of osteoporotic vertebral fractures seems to result in higher primary costs compared to conservative treatment. However it is still unclear whether the inpatient related follow-up costs don’t result in a different outcome. The aim of this analysis was a nationwide comparison of spine related inpatient treatments after balloon kyphoplasty versus conservative treatment of balloon kyphoplasty patients.
Data from the Austrian DRG-system, which includes all inpatients treated in Austria have been used to identify admission of the target population between 2002 and 2006. Because no unique patient identifier is available in the data set, a matching according to data of birth, gender and postal code was used. Outpatient visits are not included. From these data the number of admissions, the length of stay and the scores can be determined. Furthermore each admission was classified as spine related or not. To calculate the exact follow up times the data were matched against the Austrian death registry. If a patient has died this data was used to calculate the follow up time otherwise December 31st 2006 was used. The mean age of the conservative group was 75.49 and of the kyphoplasty group 71.16 years. The total follow up time was 324.55 years(mean +standard deviation 2.92+−1.40) for the conservative and 354.25 (2.53+−0.96) for the kyphoplasty group. The shorter mean follow up interval for the kyphoplasty group is due to the fact that in the years 2004 and 2005 more patients have been treated by kyphoplasty.
We demonstrate a long term superiority of balloon kyphoplasty compared to non-surgical treatment regarding inpatient treatments.
