Occupational Therapy for Establishing a Morning Routine to Prevent Delirium After Hip Fracture Surgery: A Randomised Controlled Feasibility Study

Abstract

Background: Older patients are at a greater risk of developing postoperative delirium following hip fractures. Thus, multicomponent, non-pharmacological interventions are recommended for preventing delirium. However, there is no consensus on the specific components that should be included in these interventions. Therefore, we developed an occupational therapy to establish a morning routine (OT-EMR), incorporating the three components recommended in a Cochrane review. This study aimed to assess the feasibility of this program in patients aged ≥ 80 years following acute hip fracture surgery. Methods: This randomised controlled feasibility trial compared the outcomes of usual occupational therapy with those of OT-EMR, which included daily interventions to support independence in activities of daily living each morning and group therapy sessions. Both groups received standard care, including early mobilisation, nutritional regulation, and other standard measures. The primary outcomes were delirium occurrence within 14 postoperative days and quality of life (QOL) on postoperative days 7 and 14. Results: Forty-nine patients were enrolled (recruitment rate: 51.0%), and 45 patients (mean age: 89.2 years, standard deviation: 5.1) completed the study. The retention rate of the OT-EMR was 88.0%. The respective incidence of delirium and the median duration of delirium were 45.5% and 1.5 days in the OT-EMR group, compared with 56.5% and 3.0 days in the control group. The respective mean QOL values on days 7 and 14 were 0.570 and 0.612 in the OT-EMR group, compared with 0.475 and 0.560 in the control group. Effect sizes were small across all outcomes. Conclusions: Implementation of OT-EMR was feasible, but its effects on delirium incidence and QOL were small. Further improvements in the program implementation and research methods are essential for study continuation. Trail Registration: University Hospital Medical Information Network Clinical Trials Registry number: UMIN000055541.