Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression

Diong, Joanna; Allen, Natalie E.; Sherrington, Catherine

doi:10.1136/bjsports-2014-094465

Cited by 81 publications

(66 citation statements)

References 47 publications

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“…Specifically, extended exercise programs outside the hospital (e.g. at home) improve physical functioning [24, 47]. Similarity to persons with signs of frailty, there is also evidence for hip fracture patients that individualized, multicomponent and progressive rehabilitation enhance functional capacity [18, 23].…”

Section: Discussionmentioning

confidence: 99%

“…Frailty is an indication to start physical exercise [19] to improve functional capacity [20]. Multicomponent exercise interventions (including aerobic, strength, balance and flexibility exercises) reduce the incidence, prevalence and severity of frailty [21, 22], and enhance functional capacity [18, 23] and overall mobility [24] of hip fracture patients.…”

Section: Introductionmentioning

confidence: 99%

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Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

Soukkio

Suikkanen

Kääriä³

et al. 2018

BMC Geriatr

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BackgroundHealth concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation.We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture.MethodsThis is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried’s frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant’s home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant’s home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months.DiscussionOur trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.Trial registrationClinicalTrials.gov Identifier: NCT02305433, Registered Nov 28, 2014.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

Soukkio

Suikkanen

Kääriä³

et al. 2018

BMC Geriatr

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“…Post hip fracture patients have an increase in disabilities at three months and 80% have not returned to baseline at one year (80). There is emerging evidence that an aggressive long term program including resistance exercise can markedly improve outcomes in older persons following hip fracture (81,82). Importantly it appears that progressive strength training should be started in hospital (83) and carried out into the rehab setting.…”

Section: Rehabilitationmentioning

confidence: 99%

Orthogeriatrics and Hip Fractures

Sanford

Morley

McKee

2018

The Journal of nutrition, health and aging

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“…The general aim of postoperative physiotherapy (PT) treatment is for the patient to regain physical function and strength towards the prefracture level of activity; however, the optimal treatment is still not established [16,17]. Despite this, a recent systematic review with meta-analysis and meta-regression provides some evidence for a positive effect on mobility of structured exercise interventions including progressive strength training (ST) after HF [18]. However, these findings are primarily based on studies evaluating prolonged outpatient interventions [18].…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, a recent systematic review with meta-analysis and meta-regression provides some evidence for a positive effect on mobility of structured exercise interventions including progressive strength training (ST) after HF [18]. However, these findings are primarily based on studies evaluating prolonged outpatient interventions [18]. The efficacy of very early interventions including standard care rehabilitation are much less studied in patients with HF, although promising results have been found after hip replacement surgery [19] and recently regarding the feasibility of ST initiated within the first days after HF surgery [20].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture: A randomised controlled trial

et al. 2017

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QuestionIs acute in-hospital physiotherapy with additional progressive knee-extension strength training (ST) of the fractured limb more effective in reducing knee-extension strength deficit at follow-up compared to physiotherapy without strength training in patients with a hip fracture?DesignAssessor blinded, randomised controlled trial with intention-to-treat analysis.Participants90 patients with a hip fracture admitted to an acute orthopaedic Hip Fracture Unit at a university hospital between October 2013 and May 2015.InterventionDaily physiotherapy with or without progressive knee-extension strength training (10RM), 3 x 10 repetitions, of the fractured limb using ankle weight cuffs conducted by ward physical therapists during hospital stay.Outcome measuresPrimary outcome was the change in maximal isometric knee-extension strength in the fractured limb in percentage of the non-fractured limb from inclusion to postoperative day 10 or discharge (follow-up). Secondary outcome was Timed Up and Go test measured early after surgery and at follow-up.ResultsIn the intention-to-treat analysis of between-group differences, the primary outcome improved 8.1% (95% CI -2.3; 18.4) by additional strength training from baseline to follow-up. In the per-protocol analysis of non-missing data, significant between-group improvements by 10.5% (95% CI 0.3; 20.7) were found in favour of additional ST. No significant between-group differences were found in any secondary outcome.ConclusionPhysiotherapy with addition of 5 sessions of ST yielded no additional improvements compared to physiotherapy without strength training in reducing the knee-extension strength deficit at follow-up in patients with a hip fracture. It is debatable whether larger improvements than the observed 8–10% can be expected given that only five exercise sessions, on average, were completed. In fragile patients with a hip fracture in the acute phase, where the ability to participate in functional exercise is compromised, we still consider early strength training a possibility to improve outcomes of clinical importance, given the results of the per-protocol analysis. The present data provides an important basis and call for future investigations including longer term interventions.Trial registrationClinicaltrials.gov NCT00848913

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Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression

Abstract: Structured exercise produced small improvements on overall mobility after hip fracture. Interventions that included progressive resistance training and were delivered in other settings were more effective, although the latter may have been confounded by duration of interventions.

Cited by 81 publications

References 47 publications

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

Orthogeriatrics and Hip Fractures

Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture: A randomised controlled trial

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