Does a physical therapist-led, home-based walking exercise behavior change intervention improve walking capacity compared with usual care in adults with peripheral artery disease and intermittent claudication?
FindingsIn this randomized clinical trial that included 190 participants with intermittent claudication due to peripheral artery disease, receipt of the intervention, compared with usual care, resulted in a statistically significant adjusted difference in mean six-minute walk distance at 3-months of 16.7m.
MeaningAmong adults with peripheral artery disease, a home-based walking exercise behavior change intervention, compared with usual care, increased six-minute walking distance at 3-months.
Femoral neck fractures are a major source of disability in the elderly. Rehabilitation is fundamental to recover pre-fracture functionality. We conducted an observational cohort study with the aim of comparing the efficacy of rehabilitation programs in different therapeutic settings. We included elderly patients who had undergone surgical stabilization of a hip fracture. The participants were divided into 3 groups: group 1, outpatient rehabilitation; group 2, inpatient rehabilitation; group 3, home-based rehabilitation. Patients were evaluated at baseline, at three months, and at six months after fracture. Our outcome measures were the Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, and muscle strength in hip flexion, abduction, and knee extension. At six months, all three groups showed an average statistically significant improvement (p < 0.05) in all outcome measures compared to the baseline. Considering the between-group analysis, final BI was significantly higher in outpatient than inpatient-treated patients (p = 0.018), but no statistical difference was found between outpatient and home-based patients. Our findings suggest that rehabilitation leads to significant functional recovery after hip fracture in elderly patients. Both outpatient and home-based rehabilitation seem to be reasonable options for hip fracture rehabilitation.
Background: Hip fractures are a major source of disability in the elderly and rehabilitation is mandatory to recover pre-fracture functioning. To date, there is a big heterogeneity not only in terms of frequency and timing but also of choosing the most appropriate setting for hip fracture rehabilitation. In this real-practice pilot study we aimed at evaluating the long-term effects of rehabilitative intervention on disability status and functional outcomes in post-hip fracture elderly people.Methods: We included patients aged 65 years or older who had undergone surgical stabilization of a hip fracture. Exclusion criteria: pathological fractures or whose comorbidities could have an impact on motor, cognitive or sensory function. The sample was divided into 3 groups according to their destination after hospital discharge: Group 1, outpatient rehabilitation; Group 2, inpatient rehabilitation; Group 3, home-based rehabilitation. All three groups underwent a specific rehabilitation protocol for 3 times/week for 2 months. At the baseline (T0), at 3 months (T1), and at 6 months after fracture (T2), we assessed as outcome measures: Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, Medical Research Council scale (MRC) to assess muscle strength in hip flexion, hip abduction, and knee extension.Results: All three groups showed an average statistically significant improvement (p<0.05) in all the outcome measures compared to baseline, except for MRC of knee extension in group 3 at T1. Considering the between-group analysis, BI was significantly higher in Group 1 than in Group 2 at T2 (p=0.018).Conclusions: Taken together, our findings show that rehabilitation could lead to a significant improvement in functional recovery, independently from the settings, albeit outpatient rehabilitation seems to be the best option for hip fracture patients.
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