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IntroductionPatients with fragility fractures are two times as likely to suffer future fractures as their peers who have not suffered a fracture. In addition, 40% of those who suffer fragility fractures do not recover their level of functioning in terms of activities of daily living after 1 year. The present study aims to verify the hypothesis that a semipersonalised home-based exercise intervention may improve patients’ independence and reduce the number of hospital admissions compared with usual care for a population that suffers fragility fractures.Methods and analysisThis parallel-arm single-blinded randomised-controlled trial will take place at the University of Cordoba (Spain) between September 2022 and September 2024. Patients aged >50 years old who have undergone surgery for a fragility hip fracture and who were prefracture independent (Barthel index (BI)>60) will be invited to participate. Patients will be excluded if they present a different type of fracture, mild or greater cognitive impairment or contraindication to exercise training. Patients will then be randomised into exercise or usual care group. The former will receive a daily walking appointment (number of steps to be completed inside home, interspersed with sit-to-stand movements) with the total volume increasing weekly. The latter will receive the usual care. The outcomes, collected at baseline, at the end of training (3 months) and at follow-up (6 months) by blinded operators will include the BI and number of readmissions (primary outcomes) and quality of life, exercise capacity, strength, cognitive status, bone mineral density and laboratory biomarkers (secondary outcomes). Variables related to quality of life, cognitive status, laboratory markers and densitometry will also be analysed.Ethics and disseminationThe research ethics committee of the province of Cordoba approved the project (number 326; date 28 July 2021). Patients who meet the eligibility criteria will receive a patient information document and the consent form and will be encouraged to ask any questions. The proposed research respects the fundamental principles of the Declaration of Helsinki, the Council of Europe Declaration on Human Rights and Biomedicine, the UNESCO Universal Declaration on the Human Genome and Human Rights, and the Oviedo Council on Human Rights and Biomedicine. The data obtained in this study will be confidential. They will be treated by the Organic Law 3/2018, of 5 December, on the Protection of Personal Data and Guarantee of Digital Rights, keeping it strictly confidential and not accessible to unauthorised third parties, and the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on Data Protection (RGPD). Written informed consent will be obtained from all the participants. The study’s results will be published in peer-reviewed journals and presented at scientific congresses worldwide. The results will also be disseminated through patient advocacy group newsletters and social media platforms. Patient partners will help select the appropriate channels and develop plain-language summaries tailored to their communities’ needs.Trial registration numberClinicalTrials.gov ID: NCT04934358 (registration date: 14 June 2021).

Background Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. Methods A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. Results A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p  < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. Conclusions A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies. Trial registration The project was registered on the Clinical Trials Registry NCT04367298 (29/04/2020).

Background Accidental falls in hospitals are serious events concerning the safety of the patients. Recent studies demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. The aim of the study is to determine the effect of the application of a programme of preventive measures based on the temporal patterns of the risk factors on the hospital fall occurrence. Methods A mixed-method research design. The following three phases will be carried out: 1) Longitudinal prospective study in two parts: (a) audits and seminars of healthcare professionals focused on an effective and efficient hospital falls register. Multi-Component and Single Cosinor analyses will be performed to obtain the temporal patterns of hospital falls and their related variables and (b) implementation of a based-temporal patterns, multidimensional prevention programme. 2) Retrospective study of falls registered in institutional databases. 3) Qualitative study based on focus groups (physicians, nurses and nursing assistants). The study protocol was approved in 2018. Discussion With regard to the safety of patients, hospital falls are serious events. Recent studies have demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. It is imperative to study temporal patterns of hospital falls to effectively and comprehensively define the aetiology of falls and, therefore, design preventive strategies. A reduction of the number of in-hospital falls and related injuries is expected, as well as an improvement in the quality of life of patients. Considering temporal patterns and levels of mood and sleep of healthcare professionals will achieve an improvement in patient safety. Trial registration Retrospectively registered in ClinicalTrials.gov ID: NCT04367298.

Background/Objectives: Fragility fractures cause disability, independence loss, and death in older adults with osteoporosis. While exercise rehabilitation is recommended, its effectiveness and consistency in improving function, quality of life, and outcomes after a fracture remain uncertain. This study aimed to systematically assess the impact of structured exercise programs on physical function, quality of life, falls, morbidity, and mortality among adults recovering from fragility fractures. Methods: This review and meta-analysis followed PRISMA guidelines, with protocol registration in PROSPERO (CRD42024503933). MEDLINE, PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched. Randomized controlled trials and quasi-experimental studies including adults (mean age ≥ 50 years) with fragility fractures were eligible if they evaluated structured exercise programs lasting ≥8 weeks compared with usual care or minimal intervention, and reported physical function, quality of life, falls, mortality, or morbidity outcomes. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Primary outcomes comprised physical function, strength, balance, and health-related quality of life. Random-effects meta-analysis was applied where data were comparable. Results: Twenty-six studies with 4142 participants were included (n = 4142; ~80.4% women; mean age ~74.83 years). Interventions were mainly multicomponent (strength, balance, mobility, and functional training). Exercise improved physical function outcomes. At 12 months, pain measured by QUALEFFO-41 decreased (MD −11.61; 95% CI −22.99 to −0.23). Effects on strength, balance, and cognitive outcomes were inconsistent. Conclusions: Exercise-based rehabilitation after fragility fractures may improve physical function and reduce pain, but pooled effects are inconsistent and often highly heterogeneous. Evidence for effects on falls and mortality is sparse and does not support firm conclusions. Physical function measures may be the most practical primary endpoint for evaluating these interventions, interpreted cautiously. Funding: PIGE-0040-2020.

We aimed to test the effectiveness of an invidually tailored home-based exercise intervention compared with usual care for independence, functional capacity and quality of life in patients with hip fragility fractures. In this single-blinded randomized-controlled trial (NCT04934358), patients with surgically treated fragility hip fractures were randomized to receive a 3-month exercise intervention or usual care. The exercise group performed a predetermined number of steps per day with resting pauses and a number of sit-to-stand exercises at home. The outcomes collected at baseline, at the end of the program and at follow up (6-months) included: the Barthel Index (primary outcome), quality of life, cognition and depression levels, 6-minute walking test, and 5-time sit-to-stand test. A total of 35 patients were randomized: 16 to the exercise group and 19 to the control group (mean age 80 ± 10 years, men n = 9). At the end of the program, patients in the exercise group presented significantly greater improvement in all primary and secondary outcomes than those in the control group did (Barthel Index variations: 12 ± 4 vs. 7 ± 5; p = 0.046), although both groups exhibited significant improvements from baseline for almost all the outcomes. Compared with usual care, a simple, individually tailored home-based exercise program favored the recovery of independence, quality of life, and functional capacity after hip fragility fractures.