Recumbent cycling to improve outcomes in people with hip fracture: a feasibility randomized trial

Abstract

Background Early mobilization after surgery is a key recommendation for people with hip fracture, however this is achieved by only 50% of people. Recumbent bike riding has been used in other populations with limited mobility and has potential to allow early exercise in people post hip fracture. The primary aim of this pilot trial was to demonstrate the feasibility of a trial protocol designed to determine the effect of early post-operative cycling in bed on outcomes in people with hip fracture. Methods Single-blinded, multi-site randomized controlled pilot trial. Fifty-one people with hip fracture were recruited within 4 days of surgery from two sites in Victoria. Participants were randomly allocated to receive either usual care (n = 25) or usual care plus active cycling in bed (n = 26). The cycling intervention was delivered on weekdays until the participant could walk 15 m with assistance of one person. The primary outcomes were trial feasibility and safety. Clinical outcomes, including mobility (Modified Iowa Level of Assistance Scale) and delirium were measured at day seven post-operatively and at hospital discharge by an assessor blinded to group. Additional outcomes at discharge included gait speed, cognition and quality of life. Results The intervention was safe, feasible and acceptable to patients and staff. Delivery of the intervention was ceased on (median) day 9.5 (IQR 7, 12); 73% of scheduled sessions were delivered; (median) 4 sessions (IQR 2.0, 5.5) were delivered per participant with (median) 9 min 34 s (IQR 04:39, 17:34) of active cycling per session. The trial protocol was feasible, however at day seven 75% of participants had not met the criterion (able to walk 15 m with assistance of one person) to cease the cycling intervention.. Conclusion In bed cycling is feasible post-operatively following hip fracture, however seven days post-operatively is too early to evaluate the impact of the cycling intervention as many participants were still receiving the intervention. A fully powered RCT to explore the effectiveness and cost efficiency of this novel intervention is warranted. Trial registration The trial was prospectively registered (25/09/2017) with the Australian New Zealand Clinical Trials Registry ACTRN12617001345370.

Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis

“…One RCT ( n = 100) [ 49 ] compared patients receiving occupational therapy training to those receiving conventional nursing care only, finding no significant difference in early mobilisation physical function. One RCT ( n = 51) [ 24 ] compared recumbent cycling to usual care reporting similar between group function. One non-RCT ( n = 150) [ 50 ] compared a preoperative mobilisation program with usual care finding significant improvements in physical function using the modified Barthel Index on admission day 3 and at discharge.…”

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

“… 0.30 m/s ±0.22 (unknown) Mård [ 28 ] Finland Exercise 6 months up to 7 years after hip fracture 12 weeks 46/43 Gait speed (undisclosed) 10-m walking test/photocells 3.5 years after hip fracture 1.37 m/s ±0.25 (fast) Overgaard [ 29 ] Denmark multi-center Exercise Average 18 days post-surgery 12 weeks 100/74 Gait speed (S) 10-m walk test/equipment not specified Mean 18 days post-surgery 0.8 m/s ±0.2 (fast) Portegijs [ 30 ] Finland Exercise Mean 4.3 (range: 0.5–7) years after hip fracture 12 weeks 45/42 Gait speed (S) 10-m walk test/photocells Mean 4.3 years after hip fracture Between 1.4 and 1.6 m/s according to Fig. 1 (fast) Portegijs [ 31 ] Finland Exercise 0.5–7 years after hip fracture 12 weeks 46/43 Gait speed (S) 10-m walk test/photocells Mean 1587±736 days after hip fracture 1.1 m/s (95% CI: 1.0–1.2) (normal) Said [ 32 ] Australia, two sites Exercise Early post-surgery during hospital stay Until participants could walk 15 m with assistance of one person 51/34 Gait speed (S) 6-m walk test/equipment not specified Discharge from hospital day Median 0.33 m/s (IQR 0.19, 0.50) (unknown) Senserrick [ 33 ] Australia Exercise At admission to rehabilitation ward at a hospital Until discharge from rehabilitation ward 76/67 Daily steps, daily walking time (S) ActivPAL (minimum 3 days) NA Sherrington [ 34 ] Australia ...…”

“…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 ].…”

Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed methods implementation evaluation

“…All hospital length of stay data is likely to have a positively skewed distribution, so we planned non-parametric Mann-Whitney-U testing to analyse all length of stay data [ 27 ]. However, once data analysis began, we found unequal variance and sufficient differences in shape of the distribution between our samples such that the planned Mann-Whitney U test would not be sufficiently robust, so we used Welch’s test instead, a t-test allowing for unequal variance [ 28 ].…”