Prolonged strength training in older patients after hip fracture: a randomised controlled trial

Sylliaas, Hilde; Brovold, Therese; Wyller, Torgeir Bruun; Bergland, Astrid

doi:10.1093/ageing/afr164

Cited by 55 publications

(56 citation statements)

References 27 publications

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“…These increases emphasise the importance of adjusting weight loads on a set-to-set basis, as reported in previous studies of patients after knee arthroplasty [37] , for the strength training to be progressive, compared to re-evaluation every 2-wk [3] or over a longer interval [15,16] , using a one-RM estimation for the training.…”

Section: Weight Loadmentioning

confidence: 71%

“…Thus, reducing strength deficits should be a high priority in rehabilitation, as the incidence of falls is higher with asymmetrical lower extremity power [7] . Some trials have suggested the benefits of exercise after hip fracture [8] , but studies have most often commenced as extended programmes after standard physical therapy has ceased, 6 to 8 wk after fracture at the earliest [9][10][11][12][13][14][15][16] . To our knowledge, only one study has evaluated the effects of early 6-wk (median of 15 d postsurgery) strength training after hip fracture as an inpatient rehabilitation programme [3] .…”

Section: Introductionmentioning

confidence: 99%

“…However, no similar studies have been conducted in community-dwelling geriatric patients with hip fractures or have succeeded in promoting the regaining of symmetrical lower limb muscle strength. In addition, most strength intervention studies have based their training intensity on the one repetition maximum (RM) level [3,[10][11][12][15][16][17] , which requires further calculations before use in clinical practice, as well as new one-RM measurements for the subsequent adjustment of training intensity. Such one-RM-based programmes challenge progressive exercise in comparison with, e.g., programmes that start with 12 repetitions and a 12-RM intensity, which in principal, allows physiotherapists to adjust weight loads after each set.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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AIM:To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients. METHODS:This prospective, single-blinded cohort study evaluated 31 community-dwelling patients from four outpatient geriatric health centres aged 60 years or older, who started a 6-wk programme at a mean of 17.5 ± 5.7 d after hip fracture surgery. The intervention consisted primarily of progressive fractured kneeextension and bilateral leg press strength training (twice weekly), with relative loads commencing at 15 and increasing to 10 repetitions maximum (RM), with three sets in each session. The main measurements included progression in weight loads, hip fracture-related pain during training, maximal isometric knee-extension strength, new mobility score, the timed up and go test, the 6-min walk test and the 10-meter fast speed walk test, assessed before and after the programme. RESULTS:Weight loads in kilograms in the fractured limb knee-extension strength training increased from 3.3 ± 1.5 to 5.7 ± 1.7 and from 6.8 ± 2.4 to 7.7 ± 2.6, respectively, in the first and last 2 wk (P < 0.001). Correspondingly, the weight loads increased from 50.3 ± 1.9 to 90.8 ± 40 kg and from 108.9 ± 47.7 to 121.9 ± 54 kg in the bilateral leg press exercise (P < 0.001). Hip fracture-related pain was reduced, and large improvements were observed in the functional outcome measurements, e.g. , the 6-min walk test improved from 200.6 ± 79.5 to 322.8 ± 68.5 m (P < 0.001). The fractured limb knee-extension strength deficit was reduced from 40% to 17%, compared with the non-fractured limb. Ten patients reported knee pain as a minor restricting factor during the last 10 RM knee-extension strength-training sessions, but with no significant influences on performance. CONCLUSION:Progressive strength training, initiated shortly after hip fracture surgery, seems feasible and does not increase hip fracture-related pain. Progressive strength training resulted in improvement, although a strength deficit of 17% persisted in the fractured limb compared with the non-fractured limb. Core tip: The recovery of strength and function in patients with hip fractures is an on-going challenge. We aimed to evaluate the feasibility of a 6-wk progressive lower limb strength-training programme. To our knowledge, this was the first study to implement such a program successfully in an outpatient geriatric setting within 2-3 wk after hip fracture surgery. Training loads, muscle strength and functional performances improved without an increase in hip fracture-related pain, which

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Section: Weight Loadmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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“…Other previous studies have shown that strength training interventions lasting from one to four months and implemented in the home setting or in outpatient clinic, have had positive effects on lower extremity strength (Hauer et al 2002, Mangione et al 2005, Sherrington & Lord 1997, Sylliaas et al 2012a, balance and mobility (Hauer et al 2002, Sherrington & Lord 1997. In addition, a six-month multicomponent rehabilitation at the outpatient clinic improved both the main outcomes of the intervention, viz.…”

Section: Rehabilitation After Hip Fracturementioning

confidence: 86%

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

Salpakoski

Törmäkangas

Edgren

et al. 2014

Journal of the American Medical Directors Association

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“…[2][3][4] Although trials of rehabilitation in the home environment indicate cost effectiveness for many conditions, there is lack of robust evidence toward comparability of the effect of the hospital versus alternative environments. 2,5,6 The evidence is strongest for stroke 7 followed by elective joint surgery 1,8,9 and several other conditions. 1,[8][9][10][11] Rehabilitation in the home (RITH) schemes generally aim to provide short-term, person-centred care in selected cases.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of 'rehabilitation in the home' service

Bharadwaj

Bruce²

2014

Aust. Health Review

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Objectives. Rehabilitation in the home (RITH) services increasingly provide hospital substitution services. This study examines clinical outcomes in a large metropolitan RITH service in Western Australia.Methods. The 2010 database of Fremantle Hospital RITH service was interrogated to identify the clinical profile of cases, length of stay (LOS) and clinical outcomes. Negative outcomes included death or unexpected hospital readmission. Multiple logistic regression modelling was used to explore associations with negative outcomes. This study was reviewed by the Institutional Review Board which deemed it not to require ethics approval.Results. There were 1348 cases managed by RITH: 70.6% were aged !65 years; elective joint replacement (29.7%), medical conditions (20%), stroke (13%), hip fractures (10%) were major contributors. The majority (93.3%) were discharged after a median of 9 days. Negative outcomes occurred in 90 cases (6.7%), including five deaths (0.4%) and 85 readmissions (6.3%). Independent associations with negative outcomes included older age (odds ratio (OR) (95% CI); 1.02, P = 0.006), orthopaedic conditions (OR 1.91, P = 0.004) and longer inpatient LOS (OR 1.96, P = 0.003). Age above 80 years was independently associated with risk of negative outcome (OR 2.99, P = 0.004).Conclusions. RITH had a low rate of negative outcomes. The database proved useful for monitoring quality of service provision.What is known about the topic? Rehabilitation in the home environment has proven cost effective for multiple conditions, particularly stroke and elective joint surgery, among others, facilitating better quality of life, with reduced rates of delirium and mortality. Overall there are few negative outcomes and death is rare. What does this paper add? Although RITH services are widely utilised as bed substitution services, there is scant literature on clinical outcomes while within the service. This study focuses on frequency of good and poor clinical outcomes in a well-established RITH service in Western Australia, suggesting pattern recognition of an at-risk cohort by identifying potentially useful predictors of poor outcome. What are the implications for practitioners? RITH services are a safe alternative for many, including older people. Health administration databases are useful tools to monitor clinical outcomes. Clinical indicators such as older age, long hospital stay and orthopaedic diagnoses may be useful predictors of poor outcomes in such services.

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Prolonged strength training in older patients after hip fracture: a randomised controlled trial

Cited by 55 publications

References 27 publications

Feasibility of progressive strength training shortly after hip fracture surgery

Feasibility of progressive strength training shortly after hip fracture surgery

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

Effectiveness of 'rehabilitation in the home' service

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