title: HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial.
abstract: OBJECTIVE
  To investigate the effects of intensive acute hospital physiotherapy for patients with isolated hip fractures.
  
  
  METHODS
  Single-institution, prospective, randomised trial at a level 1 trauma centre in Melbourne, March 2014 - January 2015.
  
  
  METHODS
  92 patients aged 65 years or more with isolated hip fractures. Patients were excluded if the fracture was subtrochanteric or pathological, or if post-operative orders required the patient to be non-weight-bearing on the operated leg.
  
  
  METHODS
  Randomisation to usual care physiotherapy (daily; control group) or intensive physiotherapy (three times daily; intervention group).
  
  
  METHODS
  Outcomes were assessed at post-operative Day 5, at discharge, and at 6 months. The primary outcome was the modified Iowa Level of Assistance (mILOA) score, with other outcome measures including Timed Up and Go test performance and hospital length of stay (LOS).
  
  
  RESULTS
  After controlling for sex, anaesthetic type and home setting, the between-group difference in Day 5 mILOA score favoured the intervention group (mean difference v control group, -2.7 points; P = 0.04). Hospital LOS was also shorter for the intervention group (median, 24.4 days v 35.0 days; P = 0.01). A Cox proportional hazard model that controlled for potential confounders indicated that the probability of discharge was greater for intervention group patients at all time points following surgery (P < 0.001). Re-admission and complication rates and 6-month outcomes for the two groups were not significantly different.
  
  
  CONCLUSIONS
  Intensive acute hospital physiotherapy is safe and reduces hospital LOS after an isolated hip fracture. This has the potential to improve bed flow, given the large numbers of inpatient beds occupied by this patient population.
  
  
  BACKGROUND
  Clinical Trials Registry #NCT02088437.
authors.affiliation: Alfred Hospital, Melbourne, VIC l.kimmel@alfred.org.au.
authors.forename: Lara A
authors.initials: LA
authors.lastname: Kimmel
authors.affiliation: Alfred Hospital, Melbourne, VIC.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Liew
authors.affiliation: Alfred Hospital, Melbourne, VIC.
authors.forename: James M
authors.initials: JM
authors.lastname: Sayer
authors.affiliation: Alfred Hospital, Melbourne, VIC.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D014193:Trauma Centers; D014739:Victoria