Humeral Fractures, Proximal Clinical Trial
Official title:
Effectiveness of a Home Telerehabilitation Program for People With Proximal Humerus Fracture Treated Conservatively: a Randomized Clinical Trial.
The main objective of the study is to compare the clinical effects of the innovative telerehabilitation approach (TELE group) compared to face-to-face visits to a clinic (CLINIC group) for patients treated for a proximal humerus fracture.
Every year, one out of three elderly people make at least one fall, and 10% of them cause a
fracture. Of these fractures, those of the proximal humerus, the forearm and the wrist count
for approximately one third of total osteoporotic fractures in elderly people. Proximal
humerus fractures can be treated surgically (eg: pinning, plate and screws, etc..) or
conventionally by wearing a splint or a cast. Whether either of these approaches, the
individual requires rehabilitation to prevent function limitations.
Among the possible reasons for the low use of rehabilitation services, there are 1) poor
availability of rehabilitation services for fractures of the humerus; or 2) the difficulty of
the elderly to travel to receive these services because of their precarious status.
Telerehabilitation is a promising alternative approach that can help improve access to
rehabilitation services once patients are discharged from hospital.
Some studies demonstrate that physiotherapy is a significant factor in the process of healing
and functional recovery of a proximal humerus fracture, and that, for conservative or
surgical treatment. This is showed by the good recovery of patients and by their satisfaction
with the physiotherapy. In addition, since the majority of patients with a proximal humerus
fracture are elderly, it becomes relevant to find a new way to offer quick service
physiotherapy and simple and suitable to their condition.
The main objective of the study is to compare the clinical effects of the innovative
telerehabilitation approach (TELE group) compared to face-to-face visits to a clinic (CLINIC
group) for patients treated for a proximal humerus fracture.
The research hypothesis are:
1. TELE intervention will be as effective as CLINIC intervention to improve upper extremity
function.
2. TELE intervention will be as effective as CLINIC intervention to improve deficiencies of
the shoulder (increase range of motion).
3. Participants who received the TELE intervention will be as satisfied of their care as
participants who received the CLINICL intervention.
4. TELE intervention will be less costly compared to the CLINIC intervention.
Methodology: The study has a randomized control trial design. The study population of
interest is individuals who have had proximal humerus fracture and who receive a conservative
treatment at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) and who are returning
at home. Participants will be recruited during their visit at the emergency or outpatient
clinic by the medical team or research nurse assistant. The investigators expect to recruit
52 participants, that is to say 26 per group. All evaluations will be completed in the
research center/hospital and will be approximately 1.5 hour in duration. The first evaluation
will be conducted when medical team will ask for rehabilitation (T1) to allow participant
base measures to be collected. The other evaluation will be conducted immediately after the
2-month intervention (T2). The independent variable is conventional physiotherapy and
experimental intervention by telerehabilitation. The dependant variables are 1) upper
extremity function; 2) range of motion; 3) user satisfaction; 4) cost of services according
to the healthcare system.
Platform used: In this study, a platform based on a technological infrastructure that was
developed and tested in previous telerehabilitation studies will be used. The infrastructure
combines a clinical information system with videoconference components (Tandberg 550 MXP, H
264) and uses cameras that are controlled by the clinician using computer software.
The difference between the two groups will then be compared using a t-test or a chi-square
test. The economic analysis will be a type of cost-effectiveness. The cost per unit of change
in the main dependent variable (Constant Score) will be determined for the two groups (TELE
and CONTROL) and the cost differential will be established.
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