Delivery and Outcomes of a Yearlong Home Exercise Program After Hip Fracture

Abstract

Background Hip fracture affects more than 1.6 million persons worldwide and causes substantial changes in body composition, function, and strength. Usual care (UC) has not successfully restored function to most patients, and prior research has not identified an effective restorative program. Our objective was to determine whether a yearlong home-based exercise program initiated following UC could be administered to older patients with hip fracture and improve outcomes. Methods A randomized controlled trial of 180 community dwelling female patients with hip fracture, 65 years and older, randomly assigned to intervention (n=91) or UC (n=89). Patients were recruited within 15 days of fracture from 3 Baltimore-area hospitals from November 1998 through September 2004. Follow-up assessments were conducted at 2, 6, and 12 months after fracture. The Exercise Plus Program was administered by exercise trainers that included supervised and independently performed aerobic and resistive exercises with increasing intensity. Main outcome measures included bone mineral density of the contralateral femoral neck. Other outcomes included time spent and kilocalories expended in physical activity using the Yale Physical Activity Scale, muscle mass and strength, fat mass, activities of daily living, and physical and psychosocial functioning. The effect of intervention for each outcome was estimated by the difference in outcome trajectories 2 to 12 months after fracture. Results More than 80% of participants received trainer visits, with the majority receiving more than 3 quarters (79%) of protocol visits. The intervention group reported more time spent in exercise activity during follow-up (P<.05). Overall, small effect sizes of 0 to 0.2 standard deviations were seen for bone mineral density measures, and no significant patterns of time-specific between-group differences were observed for the remaining outcome measures. Conclusion Patients with hip fracture who participate in a yearlong, in-home exercise program will increase activity level compared with those in UC; however, no significant changes in other targeted outcomes were detected.

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

“…Tinetti et al (1999) studied the effects of physical and functional therapy (27). Orwig et al (2011) investigated the intervention which comprised an exercise module and a self-efficacy based motivational module (9). Both studies included a twelve-month home-intervention.…”

“…This intervention had no effect on several targeted outcomes, including coping with ADL, compared to standard care (9). In another study home rehabilitation focusing on supported discharge improved independence in IADL in communitydwelling older adults after hip fracture (10).…”

“…In one recently published study, community-dwelling hip fracture patients participated in a yearlong, home-based exercise program including physical exercise, safety assessment, and selfefficacy based motivational component (8,9). This intervention had no effect on several targeted outcomes, including coping with ADL, compared to standard care (9).…”

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

“…13,81,123,134,137,152,178 The age of the included participants could not be determined from the study reports for four studies. 171,172,181,200 Sixteen studies included only female participants 69,79,80,102,104,123,126,147,156,158,165,174,180,183,185,191 and one included only male participants. 159 The rest included participants of both genders but the majority of studies included a greater proportion of women.…”

“…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.…”