Interventions for improving mobility after hip fracture surgery in adults

Handoll, HHG; Sherrington, Catherine; Mak, Jenson

doi:10.1002/14651858.cd001704.pub4

Cited by 156 publications

(134 citation statements)

References 66 publications

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“…7-9 In contrast, the exercise intervention in this study was performed at home and was implemented with minimal contact (maximum of 4 visits) from a physical therapist, and has the potential to be incorporated into current rehabilitation protocols. With this intervention, there was no need for participants to travel outside their home or to use expensive exercise equipment.…”

Section: Discussionmentioning

confidence: 99%

“…Since this study, systematic reviews have concluded that intensive, supervised exercise programs can result in additional functional gain following hip fracture. 8,9 Although these studies demonstrate the potential for patients with hip fracture to improve their function, most efficacious programs are in essence a continuation of standard rehabilitation with close supervision and frequent visits. Given the increase in postacute care costs for hip fracture, it would be difficult to add a large amount of extended therapy to hip fracture treatment.…”

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confidence: 99%

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Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture

Latham

Harris

Bean

et al. 2014

JAMA

181

188

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IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). RESULTS Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. CONCLUSIONS AND RELEVANCE Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture

Latham

Harris

Bean

et al. 2014

JAMA

181

188

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“…Furthermore, a previous hip fracture is associated with an increased risk of new falls and injuries [5] and up to 90 % loose independence in daily tasks involving walking [6]. It remains unclear why there should be such a disproportionately large decline in gait function following a hip fracture, and there is also a lack of consensus about content and timing of interventions to maximise recovery of gait [7].…”

Section: Introductionmentioning

confidence: 99%

The long-term effect of comprehensive geriatric care on gait after hip fracture: the Trondheim Hip Fracture Trial—a randomised controlled trial

et al. 2015

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Pre- and post-surgery CGC showed an effect on gait as long as 1 year after hip fracture. These findings underscore the importance of targeting the vulnerability of these patients at an early stage to prevent gait decline in the long run. As presently, most hip fracture patients are treated in orthopaedic wards with larger focus on the fracture than on frailty, these results are important to inform new models for hip fracture care.

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“…A 2011 Cochrane review of 19 studies with interventions aimed at improving mobilization after hip fracture found methodological fl aws in many trials especially concerning inadequate follow-up. 72 The authors were unable to pool the results of 1589 participants because no 2 studies were suffi ciently alike. They concluded that there is not suffi cient evidence to support any 1 strategy for improving walking after hip fracture, whether the intervention is started during or after hospitalization.…”

Section: Resultsmentioning

confidence: 99%