Thesis defence in the University of Oulu

Doctoral Candidate

Licentiate of Medicine, M.D. Antti Lahtinen

Faculty and research unit

University of Oulu Graduate School, Faculty of Medicine, Medical Research Center Oulu

Field of study

Orthopaedics and traumatology

Date and time of the thesis defence

10.5.2019 12:00

Place of the thesis defence

Oulu university hospital, lecture hall 1

Topic of the dissertation

Rehabilitation after hip fracture. Comparison of physical, geriatric and conventional treatment.

Opponent

Professor Ilkka Kiviranta, University of Helsinki

Custos

Professor emeritus Pekka Jalovaara, University of Oulu

Physically oriented hip fracture rehabilitation reduces mortality, improves function and reduces economic costs.

This thesis suggests that intensive, physically oriented rehabilitation following hip fracture reduces mortality and the risk of permanent institutionalization compared to conventional treatment. This type of rehabilitation also reduces long-term economic costs.

Hip fracture is one of the most common injuries among the elderly, causing significant morbidity and mortality. Most patients do not gain their prefracture level of mobility and function, and up to 25% of them face potential institutionalization. Hip fracture also leads to excessive healthcare costs. It has been estimated that of the total costs, only a minority occurs during the initial treatment and subsequent rehabilitation.

The purpose of this study was to examine the effects of specialized rehabilitation following the hip fracture regarding function, institutionalization and mortality as well as evaluating the risk factors which predict poor outcomes. In addition, the aim was to evaluate the costs and cost-effectiveness of different rehabilitation methods following the fracture. A total of 538 hip fracture were randomized to one of the three rehabilitation modalities: rehabilitation unit specialized on mobilization and occupational therapy (physical rehabilitation), geriatric department (geriatric rehabilitation) and healthcare centre hospital (control group). One year after the fracture, mortality was lower in the physical rehabilitation group compared to geriatric and the control rehabilitation group. Physical and geriatric rehabilitation improved the ability of independent living. Age, poor functional status before the fracture and chronic diseases increased the mortality risk.

The rehabilitation costs were higher in the physical rehabilitation than in the conventional treatment, but the total healthcare-related costs one year after the fracture were lower in the physical rehabilitation group than in the control group. Although some earlier studies have shown that more intensive mobilization and physiotherapy may improve short-term functional independence and earlier ambulation, this study is one of the first to report a significant improved survival among patients. Earlier studies have suggested that cost-reduction strategies including early discharge from the hospital may save costs only for the hospital and shift these costs elsewhere, generating no additional benefits. This thesis suggests that intensive mobilization and rehabilitation is a recommended practice after the hip fracture, resulting in better functional recovery, survival and lower economic costs compared to routine treatment.

Dissertation

Last updated: 3.5.2019