Can targeted cognitive intervention improve rehabilitation outcome in hip fracture patients: a randomized controlled trial

Abstract

Background

Hip fractures lead to disability, loss of independence, and a decline in quality of life. Rehabilitation success depends on various factors, such as, age, pre-fracture function, level of cognitive function, nutritional status, comorbidity, and family support. Most studies exploring the question of whether cognitive-based interventions can lead to functional improvement were conducted on community-dwelling elderly individuals with acquired brain injury, dementia, and cognitive impairments. Our aim was to compare targeted cognitive intervention with conventional occupational therapy in improving rehabilitation outcomes amongst post-acute hip fracture patients.

Methods

A randomized controlled single blinded study. Eighty patients were randomly assigned to two groups: group A (intervention) received targeted cognitive intervention, based on concepts from "The multi-context approach to cognitive rehabilitation of executive dysfunction" and group B (controls) received conventional occupational therapy. T-test and chi-square tests assessed significant differences between demographic, clinical, functional variables. ANOVA with repeated measures assessed significant improvement in cognitive/functional test scores in the two groups.

Results

43 patients were assigned to the intervention group; 37 to the controls. All patients significantly improved in their cognitive tests. No significant differences were found between the groups regarding discharge scores of the cognitive test, degree of cognitive improvement, functional outcomes and patient reported outcome measures questions.

Conclusions

Targeted cognitive intervention did not lead to a better outcome in hip fracture patients. As most were cognitively impaired, further research is warranted in order to explore whether different cognitive interventions might improve their rehabilitation outcomes.