Objective. To investigate the effect of a 12-session walking skill training program of weight-bearing activities on physical functioning and self-efficacy initiated in patients 3 months after total hip arthroplasty (THA).

The walking-skill program had better effect on walking than usual physiotherapy. Weight bearing was tolerated. Implications for Rehabilitation Weight-bearing exercises are tolerated by the patients in the early stage after TKA. Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA.

BackgroundRecovery outlooks of physical functioning and quality of life after hip fracture have not changed significantly over the past 25 years. Previous research has mainly dealt with causalities and acute treatment, while the recovery process from the patients’ perspective has been less comprehensively described. Expanded knowledge of what the patients consider important in their recovery process may have important consequences for how these patients are treated in the future and thereby on future patient outcomes. The aim presently is therefore to explore how elderly patients with hip fracture enrolled in an ongoing RCT have experienced their recovery process.MethodThe study was qualitative in design. Eight frail elderly in recovery after hip fracture (aged 69–91) were interviewed in their home four months after their fracture. The interviews covered issues related to their experiences of facilitators and barriers throughout the different stages in the recovery process. The patients were already enrolled in an ongoing randomized controlled trial, examining the effects of habitual functional training during their short term stays at nursing homes. The patients were chosen strategically according to age, gender, and participation in rehabilitation. The interviews were recorded, transcribed and subjected to a method of systematic text condensation inspired by Giorgi’s phenomenological method.ResultsThe results revealed that the patients’ experiences of the recovery process fell into three main themes: “Feeling vulnerable”, “A span between self-reliance and dependency” and “Disruption from a normal life”. The feeling of gloominess and vulnerability persisted throughout. Being in recovery was also experienced as a tension between self-reliance and dependency; a disrupted life where loss of mobility and the impact of age was profoundly present.ConclusionBeing in recovery after hip fracture was experienced as a life breaking event. Based on these findings, increased focus on individualized treatment to each patient through each stage of the recovery process should be emphasized.

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CPM was not found to have an additional short-time effect compared with active physiotherapy. After three months considerable pain relief was obtained for the whole group, the patients preoperative ROM was not restored and the number of patients able to climb stairs had decreased.

Early pain reduction was registered. At 9 months, pain was equal to that in the general population, but a considerable number of patients still had problems in performing strenuous activities.

BackgroundThe efficacy of exercise interventions in the early recovery phase, i.e. started within the first three months after hip fracture, has been poorly studied compared to prolonged exercise interventions. Objective To examine the effect of exercise interventions to improve physical function in the early phase after hip fracture. Data sources Seven databases including MEDLINE via Ovid, The Cochrane Library, Embase, Cinahl, Pedro, AMED and Web of Science were comprehensively searched till December 2019. Eligibility criteria Randomised controlled trials (RCTs) of exercise interventions initiated within the first three months after hip fracture to improve physical function, were eligible for inclusion. Primary outcome was physical function assessed using walking ability, walking speed, balance, muscle strength, mobility, and endurance. Data extraction and data synthesis We conducted subgroup analyses specifically to investigate outcomes of these individual measurements. A meta-analysis was conducted to examine the overall effect of early exercise interventions. A meta-regression was conducted to examine the impact of study characteristic on exercise interventions. We used the PEDro score to determine quality of the included studies. Results Nine studies (669 patients) were included. Despite high statistical heterogeneity, there was high to moderate quality evidence that exercise provided benefit in improving physical function (standardised mean difference (SMD) 1.07; 95% CI: 0.44 to 1.70; p < 0.001). There was no statistically significant difference in outcome, when measured by the individual physical function outcome (p > 0.05). Meta-regression demonstrated no statistically significant association between study characteristics and exercise interventions (p > 0.05). Conclusion Exercise in the early phase of hip fracture rehabilitation can improve physical function. It remains unclear what type of exercise is superior in the early phase after hip fracture. Limitations This conclusion should be interpreted with caution given the high statistical heterogeneity reported and non-significant subgroup analyses of specific physical function measures, which were underpowered.

BackgroundThe survivors after hip fracture often report severe pain and loss of physical functioning. The poor outcomes cause negative impact on the person’s physical functioning and quality of life and put a financial burden on society. Rehabilitation is important to improve physical functioning after hip fracture. To maintain the continuity in rehabilitation we have an assumption that it is of utmost importance to continue and progress the functional training that already started at the hospital, while the patients are transferred to short-term stays in a nursing home before they are returning to home. The aim presently is to examine the effects of a functional training program, initiated by the physiotherapist and performed by the nurses, on physical functioning while the patients are at short term stays in primary health care.Methods/designInclusion and randomization will take place during hospital stay. All patients 65 years or above who have sustained a hip fracture are eligible, except if they have a score on Mini Mental State (MMS-E) of less than 15, could walk less than 10 m prior to the fracture, or are terminally ill. The intervention consists of additional functional training as part of the habitual daily routine during short term stays at nursing homes after discharge from hospital. The primary outcome is physical functioning measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are Timed “Up & Go” (TUG), hand grip strength, activPAL accelerometer, and self-reported measures like new Mobility Score (NMS), Walking Habits, University of California Los Angeles (UCLA) activity scale, Fall efficacy scale (FES), EuroQol health status measure (EQ-5D-5 L), and pain.DiscussionIssues related to internal and external validity in the study are discussed. The outline for the arguments in this protocol is organized according to the guidelines of the Medical Research Council (MRC) guidance on how to develop and evaluate complex interventions.Trial registrationClinicalTrials.gov NCT02780076.