title: Power to the patient: care tracks and empowerment a recipe for improving rehabilitation for hip fracture patients.
abstract: OBJECTIVE
  New surgical procedures, early operation and medical optimisation in patients with hip fracture have shown positive results on length of hospital stay. Our aims were to investigate whether patient empowerment along with an individually designed, postoperative rehabilitation programme could reduce length of hospital stay and whether the patients would have better chances to return to their previous living.
  
  
  METHODS
  Patients were recruited during a 12-month period 2009-2010, with an intervention group treated with an individually designed, postoperative rehabilitation programme and a control group treated in a traditional way according to the hospitals routines. Final assessment was performed 4 month after surgery. The postoperative programme for the intervention group consisted of four standardised care tracks adapted individually for the patients. Assessments of Activity of Daily Living, American Society of Anesthesiologists classification of medical disease status and Short Portable Mental Status Questionnaire and living conditions were used to determine which care track was most appropriate. The patients were cared for with focus of empowerment in their rehabilitation.
  
  
  RESULTS
  The study involved 503 hip fracture patients, 285 patients in the intervention group and 218 patients in the control group. The mean length of stay was 4 days shorter in the intervention group than in the control group (p = 0.04). Varied only to a small extent between the age groups in the intervention group and was greater between the age groups in the control. Patients in the intervention group returned to their previous living in 90% compared with 80% in the control group (p < 0.05). There were no significant differences between the age groups.
  
  
  CONCLUSIONS
  Patient empowerment administrated by specially trained nursing staff and with specialised, tailor-made rehabilitation programme may be of benefit in helping patients to a shorter hospital stay and to return to their previous living.
authors: Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
authors: Susanne
authors: S
authors: Löfgren
authors: Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors: Margareta
authors: M
authors: Hedström
authors: Division of Orthopedics and Technology, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Wilhelmina
authors: W
authors: Ekström
authors: Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
authors: Lene
authors: L
authors: Lindberg
authors: Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors: Lena
authors: L
authors: Flodin
authors: Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
authors: Leif
authors: L
authors: Ryd
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000523:psychology* / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009726:Nurses; D010358:Patient Participation / Q000379:methods* / Q000523:psychology* / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D057285:Precision Medicine / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D020127:Recovery of Function; D012044:Regression Analysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: care tracks; empowerment; hip fracture; length of hospital stay; nursing; return to previous living