Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial

Abstract

Background Recovery of function and regaining muscle strength is challenging after hip fracture. We compared the effectiveness of a 12 versus 6-weeks outpatient physical therapy program with progressive resistive training (PRT) to increase strength and physical performance. Methods This parallel, superiority, 2-group randomized controlled trial was conducted in 4 clinics enrolled community-dwelling, cognitively intact older adults (+60 years) with a surgical repair of a hip fracture and no major medical conditions. Participants received 12 or 6-weeks of PRT and standardized physical therapy, twice weekly. Pain was monitored throughout. Primary outcome was the change in the 6-minute walk test (6MWT) from baseline to 12-weeks follow-up. Randomization via a computer-generated allocation sequence was implemented using sealed, sequentially numbered opaque envelopes and assessors were blinded to group assignment. Results Participants (81% women) with a mean (SD) age of 77 (8.1) years were enrolled at an average of 18 days post-hip fracture surgery and randomized into a 12-week group (n=50) or a 6-week group (n=50). A mean (SD) change score in the 6MWT of 143.8 (81.1) and 161.5 (84.1) meters found in the 12 and 6-week group, respectively (both exceeding the minimal clinically important difference of 55 meters). The mean between-group difference was -17.7 (95%CI -50.1, 14.8) meter. Pain during training did not exceed moderate levels nor increase as training intensity increased. Conclusion Twelve weeks of physical therapy with PRT was not superior to 6-weeks in improving walking distance. Hip fracture-related pain was relatively low and indicated strength testing and training was well tolerated.

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

“…The study citations and key characteristics are presented in Table 1 . The publication dates range from 2001 [ 26 ] to 2022 [ 29 ]. Participants in Sylliaas et al [ 37 ] were a subset of the participants in Sylliaas et al [ 36 ], with 100 of the original 150 participants included in the second phase of this two-phased RCT.…”

“…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 ].…”

“…Only three of the 32 papers included additional gait parameters from gait analysis, such as step length, cadence, double support time, single support time, base of support, percentage of single support, step width, walk ratio (step length/cadence), standard deviation of step velocity, single support asymmetry, swing time, steps per second, or step length for affected and non-affected leg [ 9 , 35 , 51 ]. One study included the distance walked during a 6-min walk test in addition to gait speed [ 29 ]. Five papers included accelerometer-based sensors and reported outcomes from real-world settings, reporting on daily steps, daily walking time, daily upright time, number of upright events, and length of upright events [ 9 , 33 , 49 , 50 , 53 ].…”

Demographic and Diagnostic Factors in Physical Therapy Attendance

“…When prescribing PT, a six-week course is typically pursued for various orthopedic injuries. This six-week time course has been demonstrated to have improved outcomes from baseline while providing similar outcomes to longer PT durations [ 16 ]. However, in an office setting, it may be challenging to determine patient adherence to the prescribed regimen and the number of sessions a patient must attend before benefits are appreciated.…”

The effectiveness of optimal exercise-based strategy for elderly patients with hip fracture: A systematic review and Bayesian network meta-analysis

“…Finally, the optimal exercise type for patients with hip fracture is unclear as traditional meta-analysis mainly focuses on comparisons of single EI 20 and lacks direct comparisons of different EIs, it is also di cult for healthcare professionals to develop the most effective exercise rehabilitation programs. Besides, in recent years, much literature has been published on EIs after hip fracture, 21,22 we urgently need to update the evidence to verify the effectiveness of the best interventions.…”