title: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture.
abstract: To conduct a rigorous feasibility study for a future definitive parallel-group randomised controlled trial (RCT) and economic evaluation of an enhanced rehabilitation package for hip fracture.
  
  
  
  Recruitment from 3 acute hospitals in North Wales. Intervention delivery in the community.
  
  
  
  Older adults (aged ≥65) who received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by clinical team) and received rehabilitation in the North Wales area.
  
  
  
  Remote randomisation to usual care (control) or usual care+enhanced rehabilitation package (intervention), including six additional home-based physiotherapy sessions delivered by a physiotherapist or technical instructor, novel information workbook and goal-setting diary.
  
  
  
  Primary: Barthel Activities of Daily Living (BADL). Secondary measures included Nottingham Extended Activities of Daily Living scale (NEADL), EQ-5D, ICECAP capability, a suite of self-efficacy, psychosocial and service-use measures and costs. Outcome measures were assessed at baseline and 3-month follow-up by blinded researchers.
  
  
  
  62 participants were recruited, 61 randomised (control 32; intervention 29) and 49 (79%) completed 3-month follow-up. Minimal differences occurred between the 2 groups for most outcomes, including BADL (adjusted mean difference 0.5). The intervention group showed a medium-sized improvement in the NEADL relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d 0.63), and a trend for greater improvement in self-efficacy and mental health, but with small effect sizes. The mean cost of delivering the intervention was £231 per patient. There was a small relative improvement in quality-adjusted life year in the intervention group. No serious adverse events relating to the intervention were reported.
  
  
  
  The trial methods were feasible in terms of eligibility, recruitment and retention. The effectiveness and cost-effectiveness of the rehabilitation package should be tested in a phase III RCT.
  
  
  
  ISRCTN22464643; Results.
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK Betsi Cadwaladr University Health Board, North Wales, UK.
authors.forename: Nefyn H
authors.initials: NH
authors.lastname: Williams
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Roberts
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Nafees Ud
authors.initials: NU
authors.lastname: Din
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Totton
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Charles
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Claire A
authors.initials: CA
authors.lastname: Hawkes
authors.affiliation: School of Psychology, Bangor University, Bangor, UK.
authors.forename: Val
authors.initials: V
authors.lastname: Morrison
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Hoare
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Williams
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Pritchard
authors.affiliation: Betsi Cadwaladr University Health Board, North Wales, UK.
authors.forename: Swapna
authors.initials: S
authors.lastname: Alexander
authors.affiliation: School of Sports, Health and Exercise Science, Bangor University, Bangor, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lemmey
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Woods
authors.affiliation: School of Health and Social Care Research, King's College, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sackley
authors.affiliation: School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Pip
authors.initials: P
authors.lastname: Logan
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Rhiannon T
authors.initials: RT
authors.lastname: Edwards
authors.affiliation: School of Healthcare Sciences, Bangor University, Wrexham, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020377:Self Efficacy; D014852:Wales
keywords: GERIATRIC MEDICINE; HEALTH ECONOMICS; QUALITATIVE RESEARCH; REHABILITATION MEDICINE