Physical activity after a hip fracture : effect of a multicomponent home-based rehabilitation program -a secondary analysis of a randomized controlled trial Turunen, Katri; Salpakoski, Anu; Edgren, Johanna; Törmäkangas, Timo; Arkela, Marja; Kallinen, Mauri; Pesola, Maija; Hartikainen, Sirpa; Nikander, Riku; Sipilä, Sarianna Turunen, K., Salpakoski, A., Edgren, J., Törmäkangas, T., Arkela, M., Kallinen, M., . . . Sipilä, S. (2017). Physical activity after a hip fracture : effect of a multicomponent home-based rehabilitation program -a secondary analysis of a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 98 (5), 981-988. doi:10.1016/j.apmr.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT ACKNOWLEDGMENTSWe thank the physiotherapists at the Central Finland Health Care District for the valuable work in the recruitment of the participants and data collection. We are also thankful to all those persons who assisted in data collection. follow-up among older people recovering from a recent hip fracture. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT7 DESIGN: Secondary analysis of a randomized, controlled, parallel-group trial.8 SETTING: Home-based rehabilitation; measurements in university laboratory.9 PARTICIPANTS: Community-dwelling people aged 60+ recovering from a hip fracture. 10Participants were randomly assigned into an intervention (n=40) or control (n=41) group on 11 average 42±23 days after discharge from hospital. 12 MEASUREMENTS:The outcome was the level of PA, which was assessed with the 13 questionnaire (a modified Grimby scale) at baseline, and 3, 6, 12 and 24 months after baseline.14 Three PA categories were defined: inactivity, light PA and moderate to heavy PA. Physical increased PA among older hip fracture patients. The increase was found to be maintained at the 26 one-year follow-up.

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At both population and individual level, HGS and KES showed a low to moderate agreement independently of age and health status. HGS alone should not be assumed a proxy for overall muscle strength.

Background: Less than half of the hip fracture patients will regain the pre-fracture level of

BackgroundTo cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture.Methods/DesignPopulation-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables.DiscussionTen weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study.Trial registrationCurrent Controlled Trials ISRCTN53680197

Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in the community. The causes of poor recovery are not fully understood. This study investigates recovery of walking outdoors and associated determinants after hip fracture. Methods. A prospective follow-up study, among clinical sample of 81 community-dwelling hip fracture patients over 60 years. Perceived difficulty in walking outdoors and 500 meters was assessed before fracture, at discharge to home (3.2 ± 2.2 weeks after surgery), and on average 6.0 ± 3.3 weeks after discharge. Potential determinants for walking recovery were assessed. Linear latent trajectory model was used to analyse changes during follow-up. Association between walking trajectories and potential determinants was analysed with a logistic regression model. Results. Two trajectories, No-to-minor-difficulty and Catastrophic, were found. Thirty-eight percent of the participants ended up in the Catastrophic trajectory for walking outdoors and 67% for 500 meters. Multivariate logistic regression analysis revealed that use of walking aid and indoor falls before fracture and prolonged pain were independently associated with catastrophic decline in both primary outcomes: difficulty in walking outdoors and 500 meters. Conclusions. A large proportion of community-dwelling older people recovering from hip fracture experienced catastrophic decline in outdoor walking. Acknowledging recovery prognoses at early stage enables individualized rehabilitation.

Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study.Portegijs, Erja; Edgren, Johanna; Salpakoski, Anu; Kallinen, Mauri; Rantanen, Taina; Alen, Markku; Kiviranta, Ilkka; Sihvonen, Sanna; Sipilä, Sarianna Portegijs, E., Edgren, J., Salpakoski, A., Kallinen, M., Rantanen, T., Alen, M., Kiviranta, I., Sihvonen, S. & Sipilä, S. (2012). Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a crosssectional study. Archives of Physical Medicine and Rehabilitation, 93 (12)

Hip fracture patients often suffer from pain for several months after surgery. This may lead to physical inactivity and subsequent mobility limitation and disability. The purpose of this study was to investigate the association between severe musculoskeletal pain and the level of physical activity in older people with a history of hip fracture. Data were collected from 60- to 85-year-old (n = 78) community-dwelling people, 0.7–7.5 years after hip fracture. Physical activity was assessed with the Yale Physical Activity Survey (YPAS). According to the YPAS summary index distribution, the participants were divided into the physically inactive and physically active groups. Musculoskeletal pain in the lower back, hip or knee region was assessed by the Visual Analog Scale. Pain was defined as severe pain if the subject rated the pain 66 mm or over (upper third of the scale) in at least one of the relevant body regions in the lower body. Thirty-three subjects (42%) experienced severe pain in the lower body, of whom 23 (70%) reported severe pain in the operated hip. Twenty-three patients (30%) used pain medication prescribed by a physician. The level of musculoskeletal pain was significantly higher in the physically inactive (62%) than in the physically active (31%) group (p = 0.011). Logistic regression analysis showed that people with severe pain had over three times (OR: 3.5, 95% CI: 1.30–9.39) the risk for physical inactivity compared to those with less or no pain. Multivariate adjustments for balance confidence, time since fracture, number of chronic diseases and type of surgery did not materially change the estimate (OR: 3.0, 95% CI: 1.00–9.30). Pain is an important associated factor of physical inactivity in older people with a hip fracture history. Pain management may be important in restoring and sustaining the level of physical activity after hip fracture. Further prospective and experimental studies are, however, needed to explore the causality between pain and physical activity as well as the role of pain management and physical activity interventions in preventing mobility limitation and disability among older people recovering from hip fracture.