Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE)

Abstract

It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.

How quality of life is measured in studies of nutritional intervention: a systematic review

“…While it can be used to measure HRQoL alone, its main purpose is to measure the ‘utility’ of health states. This version contains 4 dimensions (independent living, social relationships, physical senses and psychological wellbeing [ 86 , 92 ]) 1 [ 93 ] NHP General Self-administered questionnaire that measures an individual's physical, emotional, and social well-being in the context of their current health status [ 94 ] 1 [ 95 ] POMS2 General Questionnaire used to evaluate transient feelings and mood in individuals aged 13 years and above. It has evolved from the original POMS and is applicable in multiple settings, such as monitoring mood changes during interventions and assessing the impact of physical disease on psychological functioning [ 96 ] 1 [ 97 ] PROMIS SF General Standardized set of measures developed by the National Institutes of Health (NIH) to assess various aspects of health-related quality of life (HRQoL) from the patient's perspective [ 98 ] 1 [ 99 ] SIP General Behaviorally based measure of health status used to assess a person's perception of their health status with respect to their disease impact [ 100 ] 1 [ 101 ] CANCER QOLQ EORTC-QLQ-C30 Cancer HRQoL questionnaire for individuals with cancer incorporating five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea and vomiting), and a global health and quality-of-life scale [ 102 ] 27 [ 19 , 68 , 103 – 127 ] EORTC-QLQ-OES18 …”

Evaluation of mobility recovery after hip fracture: a scoping review of randomized controlled studies

“…The seventeen studies reporting on exercise alone interventions included one early in-hospital exercise intervention in bed [ 32 ], seven subacute exercise interventions after discharge from hospital or during inpatient rehabilitation before 5 months [ 26 , 27 , 29 , 33 , 35 , 36 , 38 ], and nine exercise interventions starting either after ending the “routine” physical therapy or usual care [ 9 , 23 , 25 , 34 ] or more than 5 months after the fracture [ 24 , 28 , 30 , 31 , 37 ]. Two studies reported on exercise combined with nutrition therapy [ 39 ] or education [ 40 ].…”

Efficacy Study of Multidisciplinary Team Participating in the Perioperative Administration for Elderly Patients With Intertrochanteric Fractures: A Prospective Randomized Controlled Trail

“…5,6 Applying the multidisciplinary collaborative diagnosis and treatment model to the perioperative management and the postoperative rehabilitation of elderly patients with intertrochanteric fractures can theoretically better cope with the risks of surgery and anesthesia, reduce preoperative evaluation time, and avoid postoperative complications, such as lung infections, pressure sores, ulcers, urinary tract infection, venous embolism of the lower extremities, and pulmonary embolism, which can definitely improve the prognosis of the perioperative period and accelerate the postoperative recovery. 7…”

“…5,6 Applying the multidisciplinary collaborative diagnosis and treatment model to the perioperative management and the postoperative rehabilitation of elderly patients with intertrochanteric fractures can theoretically better cope with the risks of surgery and anesthesia, reduce preoperative evaluation time, and avoid postoperative complications, such as lung infections, pressure sores, ulcers, urinary tract infection, venous embolism of the lower extremities, and pulmonary embolism, which can definitely improve the prognosis of the perioperative period and accelerate the postoperative recovery. 7 In this trial, the multidisciplinary collaborative diagnosis and treatment model is applied to the perioperative management and the postoperative rehabilitation of elderly patients with intertrochanteric fractures to explore the actual benefits gaining of patients and to make meaningful explorations for the formulation of the normalized multidisciplinary collaborative diagnosis and treatment model in the next step.…”