Pos0392 effectiveness of the activehip+ mhealth system on the funcional status, pain and fear of falling in older adults with hip fracture: a randomised clinical trial

Background Osteoporotic hip fracture causes a high level of dependency in older adults, as their functional status suddenly decreases greatly. In addition, the high level of pain and the fear of falling that they frequently experience maintain this decrease in functional status for a longer period. Digital health, the promotion of health through the use of Information and Communication Technologies, emerges as an option for the rehabilitation of older adults with hip fracture. Objectives To test the effectiveness of the co-created ActiveHip+ mHealth system on the recovery of the functional status and the decrease of the pain and fear of falling in older adults with hip fracture. Methods A total of 110 older adults with hip fracture and their family caregivers were recruited from hospitals in southern Spain. Participants were randomly assigned to an intervention group (n = 55), in which rehabilitation was performed through ActiveHip+, or to a control group (n = 55), in which they received standard rehabilitation for a hip fracture from the Andalusian Public Health System. Participants were assessed during the hospital stay and 3 months after surgery. Feasibility assessment was done through adoption (participation proportion), usage (access to the app), satisfaction with the app (Net Promoter Score) and user perception of the quality of the app (Mobile App Rating Scale). Clinical assessment was conducted through patient-reported outcomes, such as the Functional Independence Measure and the New Mobility Score Spanish version for functional status, the Numerical Rating Scale for pain and the Short Falls Efficacy Scale-International for fear of falling. Results We obtained positive results in terms of feasibility as we observed 88% adoption, 82% usage, 8.35/10 in satisfaction with the app and 4.3/5 in perceived quality of the app.The functional status of patients allocated to the intervention group (those using ActiveHip+) had a statistically significant greater recovery than participants of the control group at 3-months (medium effect size: 0.70 Cohen’s d; p = 0.02) and (medium effect size: 0.62 Cohen’s d; p = 0.03) respectively. In addition, the level of pain was statistically significant lower in participants of the intervention group than those in the control group (medium effect size: 0.45; Cohen’s d p = 0.03). Regarding the fear of falling, there was no statistically significant difference (medium effect size: 0.32 Cohen’s d; p = 0.17). Conclusion The ActiveHip+ mHealth system is effective in the recovery of the functional status and the decrease of pain in older adults with hip fracture. However, it was not effective on the decrease of the fear of falling. Table 1. Baseline characteristics and pre-interventions raw of sample divided by groups. Variable Intervention group ( n = 46) Control group ( n = 53) P Age (years), Mean (SD) 79.70 (7.2) 79.94 (7.8) 0.73 Sex, n (%) 0.83 Women 33 (72) 37 (70) Men 13 (28) 16 (30) Type of injury, n (%) 0.58 Fracture Cervical Femoral (Intracapsular) 21 (46) 22 (42) Fracture Trochanteric (Extracapsular) 20 (43) 23 (43) No fracture, but degeneration 5 (11) 8 (15) Type of surgery, n (%) 0.94 Prosthesis 14 (65) 13 (25) Screw Plate 30 (31) 35 (66) PFN-A Nail 1 (2) 5 (9) Others 1 (2) 0 (0) Hospital stay (days), Mean (SD) 6.83 (4.2) 5.64 (3.3) 0.08 Functional status at hospital discharge FIM (Total score 18-126) Mean (SD) NMS-ES (Total score 0-9) Mean (SD) 78.13 (19.23) 5.89 (2.31) 75,26 (13,39) 6.58 (1.73) 0.36 0.26 Fear of falling at hospital discharge SFES-I (Total score 7-28) Mean (SD) 19.37 (7.2) 20.08 (5.18) 0.58 Pain level at hospital discharge NRS (Total score 0-10) Mean (SD) 5.89 (2.31) 6.58 (1.73) 0.91 n = sample size; SD = standard deviation; PFN-A = Proximal Femoral Nail; FIM = Functional Independence Measure; NMS-ES = New Mobility Score Spanish version; SFES-I = Short Falls Efficacy Scale; NRS = Numeric rating scale Figure 1. Effect sizes of the ActiveHip+ mHealth system on the functional status, pain and fear of falling (per-protocol analysis). REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.