Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults

Magaziner, Jay; Mangione, Kathleen K; Orwig, Denise; Baumgarten, Mona; Magder, Laurence S.; Terrin, Michael L.; Fortinsky, Richard H.; Gruber‐Baldini, Ann L.; Beamer, Brock A.; Tosteson, Anna N.A.; Kenny, Anne M.; Shardell, Michelle; Binder, Ellen F.; Koval, Kenneth J.; Resnick, Barbara; Miller, Ram R.; Forman, Sandra; McBride, Ruth; Craik, Rebecca L.

doi:10.1001/jama.2019.12964

Cited by 59 publications

(95 citation statements)

References 44 publications

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“…More work is needed to establish the most responsive measures of outcomes in older people after fall-related fracture. The possible impact on some measures of balance and mobility reinforces the findings of two previous studies 12,17 reporting benefits of home exercise after hip fracture. In all three studies, the exercises were primarily "functionally relevant," that is the exercise was undertaken in weight-bearing positions rather than more traditional lying or seated exercises.…”

Section: Discussionsupporting

confidence: 85%

“…8 There are strong effects on mobility and function from intensive supervised center-based exercise interventions, 9 , 10 but effectiveness of more economically viable home-based programs is inconsistent. 8 , 11 , 12 One high-quality trial found a 6-month home exercise program, taught by a physiotherapist and undertaken with minimal supervision, improved mobility in older people after hip fracture. 13 This built on previous trials in which home exercise programs taught by physiotherapists improved short-term mobility outcomes after hip fracture.…”

Section: Introductionmentioning

confidence: 99%

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Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial

et al. 2020

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BACKGROUND: Disability and falls are common following fall-related lower limb and pelvic fractures. OBJECTIVE: To evaluate the impact of an exercise selfmanagement intervention on mobility-related disability and falls after lower limb or pelvic fracture. DESIGN: Randomized controlled trial. PARTICIPANTS: Three hundred thirty-six community dwellers aged 60+ years within 2 years of lower limb or pelvic fracture recruited from hospitals and community advertising. INTERVENTIONS: RESTORE (Recovery Exercises and STepping On afteR fracturE) intervention (individualized, physiotherapist-prescribed home program of weightbearing balance and strength exercises, fall prevention advice) versus usual care. MAIN MEASURES: Primary outcomes were mobilityrelated disability and rate of falls. KEY RESULTS: Primary outcomes were available for 80% of randomized participants. There were no significant between-group differences in mobility-related disability at 12 months measured by (a) Short Physical Performance Battery (continuous version, baseline-adjusted betweengroup difference 0.08, 95% CI − 0.01 to 0.17, p = 0.08, n = 273); (b) Activity Measure Post Acute Care score (0.18, 95% CI − 2.89 to 3.26, p = 0.91, n = 270); (c) Late Life Disability Instrument (1.37, 95% CI − 2.56 to 5.32, p = 0.49, n = 273); or in rate of falls over the 12-month study period (incidence rate ratio 0.96, 95% CI 0.69 to 1.34, n = 336, p = 0.83). Between-group differences favoring the intervention group were evident in some secondary outcomes: balance and mobility, fall risk (Physiological Profile Assessment tool), physical activity, mood, health and community outings, but these should be interpreted with caution due to risk of chance findings from multiple analyses. CONCLUSIONS: No statistically significant intervention impacts on mobility-related disability and falls were detected, but benefits were seen for secondary measures of balance and mobility, fall risk, physical activity, mood, health, and community outings.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial

et al. 2020

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“…Globally, hip fracture is a frequent cause of morbidity and mortality, particularly among elderly people [ 1 ]. Elderly patients with osteoporosis exhibit a high incidence of intertrochanteric fractures, such that one in three patients die from various complications caused by fracture within 1 year after injury [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial

Wang

Long

et al. 2021

J Orthop Surg Res

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Purpose Elderly patients with intertrochanteric fractures exhibit post-traumatic hidden blood loss (HBL). This study aimed to evaluate the efficacy and safety of reducing post-traumatic HBL via early intravenous (IV) tranexamic acid (TXA) intervention in elderly patients with intertrochanteric fracture. Methods A prospective randomized controlled study was conducted with 125 patients (age ≥ 65 years, injury time ≤ 6 h) who presented with intertrochanteric fracture from September 2018 and September 2019. Patients in the TXA group (n = 63) received 1 g of IV TXA at admission, whereas those in the normal saline (NS) group (n = 62) received an equal volume of saline. Hemoglobin (Hgb) and hematocrit (Hct) were recorded at post-traumatic admission (PTA) and on post-traumatic days (PTDs) 1–3. HBL was calculated using the Gross formula. Lower extremity venous ultrasound was performed to detect venous thrombosis. Results Hgb on PTDs 2 and 3 was statistically higher in the TXA group than in the NS group. Hct and HBL on PTDs 1–3 were significantly less in the TXA group compared to the NS group. Preoperative transfusion rate was significantly lower in the TXA group compared with the NS group. There was no difference between the two groups with regard to the rates of complications. Conclusion Early IV TXA intervention could reduce post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis.

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“…Globally, hip fracture is a frequent cause of morbidity and mortality, particularly among elderly people [1].…”

Section: Introductionmentioning

confidence: 99%

Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial

Wang

Long

et al. 2020

Preprint

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Purpose Elderly patients with intertrochanteric fractures exhibit post-traumatic hidden blood loss (HBL). This study aimed to evaluate the efficacy and safety of reducing post-traumatic HBL via early intravenous (IV) tranexamic acid (TXA) intervention in elderly patients with intertrochanteric fracture.Methods A prospective, randomized, controlled study was conducted with 125 patients (age ≥65 years, injury time ≤6 h) who presented with intertrochanteric fracture from September 2018 and September 2019. Patients in the TXA group (n=63) received 1 g of IV TXA at admission, whereas those in the normal saline (NS) group (n=62) received an equal volume of saline. Hemoglobin (Hgb) and hematocrit (Hct) were recorded at post-traumatic admission (PTA) and on post-traumatic day (PTD) 1–3. HBL was calculated using the Gross formula. Lower extremity venous ultrasound was performed to detect venous thrombosis.Results Hgb on PTD 2 and 3 were statistically higher in the TXA group than in the NS group. Hct and HBL on PTDs 1-3 were significantly less in the TXA group compared to the NS group. Preoperative transfusion rate was significantly lower in the TXA group compared with the NS group. There was no difference between the two groups with regard to the rates of complications.Conclusion Early IV TXA intervention could reduces post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis.

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Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults

Cited by 59 publications

References 44 publications

Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial

Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial

Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial

Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial

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