Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial

Abstract

The aim of this trial was to evaluate the clinical effectiveness and cost-effectiveness of a home-based exercise program delivered four months following hip-fracture surgery. In the two-armed randomized, single blinded clinical trial we included persons who lived in the catchment area, were 70 years or older, and community-dwelling at time of the fracture. We excluded persons who were unable to walk ten meters prior to the fracture, and those who were bedridden or had medical contraindications for exercise at baseline (ie. four months after the fracture). All participants underwent routine treatment and rehabilitation. The intervention group received additional 20 sessions (10 weeks) structured, home exercise targeting gait and balance, delivered by physiotherapists in primary health care. Gait speed was the primary outcome. Secondary outcomes included physical activity, gait characteristics, cognitive function, activities of daily living, health-related quality of life, and health care costs extracted from hospital and municipality records. In total, 223 participants were included. Four months post surgery 143 were randomized for the exercise trial (70% women, mean age 83.4 (SD 6.1) years, mean gait speed 0.6 (SD 0.2) m/sec). Estimated between group difference in gait speed was 0.09 m/sec (95% CI: 0.04 to 0.14, p<0.001) at posttest and 0.07 m/sec (95% CI: 0.02 to 0.12, p = 0.009) 12 months post surgery. The mean between-group QALY difference was -0.009 (95% CI: -0.061 to 0.038). The mean between-group total cost difference was +242.9 EUR (95% CI: -8397 to 8584). Our findings suggest that gait recovery after hip fracture can be improved by introducing a home-based balance and gait exercise program four months post surgery, without increasing total health care costs. Future research should focus on how to implement gait and balance exercise in comprehensive interventions that increase adherence among the most vulnerable persons and have an effect on daily life activities and patient-centred outcomes.Trial registration: ClinicalTrials.gov NCT01379456.

Feasibility and preliminary effect of anabolic steroids in addition to strength training and nutritional supplement in rehabilitation of patients with hip fracture: a randomized controlled pilot trial (HIP-SAP1 trial)

“…Disappointingly, no significant between-group difference was identified for secondary performance-or patient reported measures, while significant positive within-group changes were seen for gait, mobility and fear of falling, as expected. No within-group change were seen for hand grip strength, QoL, fatigue, depression, as in line with similar previous studies [23,41,42]. Testosterone levels for both genders were very low at baseline, but as expected higher levels of testosterone were found in the INT at follow-up.…”

Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

“…Recent results in a randomized controlled trial indicate that a structured exercise program with 20 additional sessions of physiotherapy at home leads to significant improvement of gait speed in hip fracture patients 4 months postoperatively [ 28 ]. There was a high variability of physical activity between days, which indicates that at least 4 consecutive days should be monitored [ 29 ].…”

Physical Therapy Management of Older Adults With Hip Fracture

“…Taraldsen et al 253 conducted an RCT of a 10-week, home-based balance and gait training program initiated 4 months after hip fracture in addition to usual care. Although there was significant loss to follow-up, the intervention group demonstrated a significant difference in mean gait speed.…”