Patient Participation and Physical Activity During Rehabilitation and Future Functional Outcomes in Patients After Hip Fracture

Abstract

Objective We examined the association between physical activity recorded by Actigraphy during therapy sessions (therapy) to therapist rated patient participation and self reported future functional outcomes. We hypothesized those participants who were more active during rehab would have higher participation scores and better functional outcomes following hip fracture compared to those who were less active. Design Longitudinal study with 3 and 6 month follow-up. Setting Participants were recruited from skilled nursing (SN) and inpatient rehabilitation (IR) facilities. Participants Participants included 18 community dwelling older adults admitted to SN or IR facilities after hip fracture. Participants were included if they were ≥ 60 years of age and ambulatory with or without assistance from a device or another person. Intervention Not Applicable Main Outcome Measure Physical activity was quantified during participants’ rehab using the Actigraph accelerometer worn consecutively over 5 days. The Pittsburgh Participation Rating Scale was used to quantify patient participation during their inpatient therapy sessions. Self reported functional outcomes were measured by the Hip Fracture Functional Recovery Scale (HFRS) at baseline, 3 and 6 months following fracture. Results Participants with higher Actigraphy counts during rehab were ranked by their therapists as having excellent participation compared to those who were less active. Participants who were more active reported better functional abilities at both 3 and 6 month time points and achieved 78% and 91% recovery of self reported pre-fracture function compared to those who were less active achieving 64% and 73% recovery. Conclusion Actigraphy provides an objective measure of physical activity exhibiting predictive validity for future functional outcomes and concurrent validity against patient participation in patients after hip fracture.

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…None of the participants were followed-up for the home exercise program. Variation in the rehabilitation activities and lack of guidelines for mobility limitation and disability prevention after hip fracture has been recognized worldwide [47,48]. It has been suggested that better functional outcomes could be achieved with more intensive rehabilitation and promotion of physical activity after hip fracture [47,48].…”

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

“…119 The majority of the studies included participants who were mobile and living independently in their own home or in a care home before their hip fracture. 12 [183][184][185][186]191,193,194,196,197,199,201 Only seven studies included patients with a medical or psychological comorbidity; 123,139,145,157,158,184,193 the majority of studies excluded such patients, especially when exercise would have been contraindicated. Only two studies included patients who had a history of a previous fracture.…”

“…185 Eight studies included patients aged ≥ 50 years; 87,98,103,118,173,187,188,192 18 studies included patients aged ≥ 60 years; 12,89,96,104,114,117,119,122,132,133,149,154,164,[193][194][195][196][197] 19 studies included patients aged ≥ 70 years; 69,72,79,88,106,108,110,111,116,120,131,136,143,148,150,161,180,183,184 and seven studies included patients aged ≥ 80 years. 13,81,123,134,137,152,178 The age of the included participants could not be determined from the study reports for four studies.…”

Physical Activity After a Hip Fracture: Effect of a Multicomponent Home-Based Rehabilitation Program—A Secondary Analysis of a Randomized Controlled Trial

“…6,7 In 33 addition to beneficial long-term effects of physical activity on the prevention and treatment of 34 several chronic diseases, 8 physical activity has shown to have positive short-term effects on…”