title: Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial.
abstract: BACKGROUND
  Health-related quality of life (HRQoL) has been used to assess subjects' prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery.
  
  
  METHODS
  For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models.
  
  
  RESULTS
  We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24-1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53-1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS.
  
  
  CONCLUSIONS
  The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects' odds for following a trajectory of good physical functioning after hospitalization.
  
  
  BACKGROUND
  ClinicalTrials.gov ( NCT01350557 ).
authors.affiliation: Department of Nursing, Meiho University, 23 Pingguang Road, Neipu, Pingtung, 91202, Taiwan. x00003171@meiho.edu.tw.
authors.forename: Ming-Yueh
authors.initials: MY
authors.lastname: Tseng
authors.affiliation: School of Public Health, University of Michigan, 1415 Washington Heights, M3007 SPH II, Ann Arbor, MI, 48109, USA. jliang@umich.edu.|Institute of Gerontology, University of Michigan, 1415 Washington Heights, M3007 SPH II, Ann Arbor, MI, 48109, USA. jliang@umich.edu.
authors.forename: Jersey
authors.initials: J
authors.lastname: Liang
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan. yeaing@mail.cgu.edu.tw.|Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan. yeaing@mail.cgu.edu.tw.
authors.forename: Yea-Ing L
authors.initials: YI
authors.lastname: Shyu
authors.affiliation: Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan. ccwu@mail.cgu.edu.tw.
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan. hscheng@adm.cgmh.org.tw.
authors.forename: Huey-Shinn
authors.initials: HS
authors.lastname: Cheng
authors.affiliation: Section of General Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan. psycychen@yahoo.com.tw.
authors.forename: Ching-Yen
authors.initials: CY
authors.lastname: Chen
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan. angel62@mail.cgu.edu.tw.
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D003131:Combined Modality Therapy; D019033:Delivery of Health Care, Integrated; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D017711:Nonlinear Dynamics; D016017:Odds Ratio; D010348:Patient Care Team; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome