Systematic home-based physical and functional therapy for older persons after hip fracture

Tinetti, Mary E.; Baker, Dorothy I.; Gottschalk, Margaret; Garrett, Patricia; McGeary, Signian; Pollack, Daphna; Charpentier, Peter

doi:10.1016/s0003-9993(97)90338-5

Cited by 66 publications

(59 citation statements)

References 19 publications

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“…The increases in isometric force production and gait speed reported by Sherrington and Lord 14 after a program of step-up exercises are consistent with the increases demonstrated in our study. In contrast, Tinetti and colleagues 15 did not report improvements in force production after 6 months of training. Training intensity, in the study by Tinetti et al, was not individualized; all patients began with the elastic band of least resistance, used the same band for ankle muscles and knee muscles, were encouraged to train daily, and could progress no further than a band that provided 1.5 to 12 lb (0.675-5.4 kg) of resistance (depending on the length of the band).…”

Section: Discussionmentioning

confidence: 85%

“…Tinetti and colleagues 15,16 compared outcomes of "usual care" rehabilitation and "systematic multicomponent rehabilitation (SMR)" at 6 and 12 months in 304 patients receiving rehabilitation in the home after hip fracture. "Usual care" was not defined, but SMR included daily performance of 3 sets of 8 repetitions for seated hip flexion, hip abduction, knee extension, and ankle dorsiflexion.…”

mentioning

confidence: 99%

“…The program described by Sherrington and Lord 14 did not report training intensity, but the results suggest that exercise in people who have had a hip fracture may have positive effects on impairments and functional limitations. Tinetti and colleagues' 15,16 program was comprehensive in scope, but it is not clear whether the training intensity was adequate to improve impairments or functional limitations.…”

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confidence: 99%

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Can Elderly Patients Who Have Had a Hip Fracture Perform Moderate- to High-Intensity Exercise at Home?

et al. 2005

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Background and Purpose. The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate-or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. Subjects. Thirty-three elderly people (24 women, 9 men; Xϭ78.6 years of age, SDϭ6.8, rangeϭ64 -89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. Methods. Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes. Results. Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed. Discussion and Conclusion. High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained.[Mangione KK, Craik RL, Tomlinson SS, Palombaro KM. Can elderly patients who have had a hip fracture perform moderate-to high-intensity exercise at home ? Phys Ther. 2005;85:727-739.] Key Words: Exercise, aerobic performance; Exercise, force production; Hip fractures; Home care services. H ip fracture is a common medical problem that can drastically change the quality of life for the elderly person. More than 300,000 older people are expected to fracture a hip each year 1 at an estimated cost of $5 billion. 2 It has been well established that the majority of patients with hip fracture do not return to prefracture functional status at 1 year after surgery. [3][4][5][6][7] In a study of 120 people, Marottoli et al 5 showed that, 6 months after hip fracture, only 8% climbed a flight of stairs, 15% walked across a room...

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Section: Discussionmentioning

confidence: 85%

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confidence: 99%

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confidence: 99%

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Can Elderly Patients Who Have Had a Hip Fracture Perform Moderate- to High-Intensity Exercise at Home?

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“…We examined the effect of salmon calcitonin nasal spray in an additional gait assessment, using the Tinetti motility score to study clinical differences in the outcome of rehabilitation in either group [40] . The Tinetti Balance Scale is a simple clinical test to measure the risk of falling.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Salmon Calcitonin Nasal Spray Treatment in Postmenopausal Women after Total Hip Arthroplasty

Peichl

Griesmacher²,

Kumpan³

et al. 2005

Gerontology

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Objective: The increasing rate of hip fractures is giving rise to a number of socio-economic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures, being performed increasingly often throughout the world. Revision rates for THA range up to 20% per year. Aseptic loosening is the reason for 75% of the revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after THA, resulting in severely impaired function, pain, and a reduced range of hip movement. Subjects: In an open study, 37 women who had undergone cementless THA after accidental hip fractures were treated twice daily with 200 IU of salmon calcitonin nasal spray for 12 months. Simultaneously the patients received one bag of 1,000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless THA were treated with only one bag of 1,000 mg calcium plus 880 IU vitamin D daily through the treatment period. Results: The results of this 12-month clinical trial show that 200 IU of salmon calcitonin nasal spray per day significantly improves the clinical outcome of postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray significantly reduces bone turnover, loss of bone density, and pain. The functional status of the patients was improved and the risk of falling reduced by rehabilitation during the observation period of 12 months. Additionally, calcitonin promoted the repair of hip fractures and was associated with a significantly lesser rate of refractures as well as periprosthetic ossifications. Conclusion: The increasing revision rate for THA during the first year and the patient’s problem of resuming their previous living habits are the main foci of our study. Calcitonin nasal spray seems to cause few side effects. The additive treatment appears to improve the clinical outcome of THA in elderly postmenopausal women.

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“…In addition, intensive and time limited supported discharge teams, that are based on the key principles shown in (Baker et al 2001, Nadash and Feldman 2003, Parsons et al 2013, Tinetti et al 2012a. Allied health (physiotherapy and occupational therapy) can teach and implement plans of treatment in cooperation with coordinators to allow individuals to maintain the maximum amount of independence that their physical condition allows (Baker et al 2001, Nadash and Feldman 2003, Tinetti et al 2002, Tinetti et al 1997, Whitehead et al 2014. In addition, there is a role for physiotherapy within the model in the application of key competencies associated with goal facilitation, task analysis and breakdown, fitness and function, strength, balance / proprioception, motor control and adaptation and in the use of skills related to exercise prescription; maximisation of mobility; falls prevention advice and education for support workers, family, patient and home care coordinators.…”

Section: Physiotherapy and Home Carementioning

confidence: 99%

Home care: An opportunity for physiotherapy?

Parsons,

Mathieson,

Parsons

2015

NZJP

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Remaining physically active in later life is critical to maintaining independence in activities of daily living and is a major contributor to overall health status amongst older people. Traditionally a key focus of physiotherapy has been on maintaining functional capacity and mobility. However, the health and disability sector is a constantly evolving entity. Clinicians from a number of disciplines, including physiotherapy, need to be flexible, responsive and innovative and maximise cost benefit for the service funder. Nicholls et al (2009) highlighted the imperative need for physiotherapists to investigate innovative models that align with current and future policy and health care reforms. Over the past 15 years there has been an increased emphasis on supporting older people to remain living at home. This article describes New Zealand and international evidence relating to the optimisation of the potential role of physiotherapy in providing rehabilitation expertise into the provision of Home Care for older people.

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Systematic home-based physical and functional therapy for older persons after hip fracture

Cited by 66 publications

References 19 publications

Can Elderly Patients Who Have Had a Hip Fracture Perform Moderate- to High-Intensity Exercise at Home?

Can Elderly Patients Who Have Had a Hip Fracture Perform Moderate- to High-Intensity Exercise at Home?

Clinical Outcome of Salmon Calcitonin Nasal Spray Treatment in Postmenopausal Women after Total Hip Arthroplasty

Home care: An opportunity for physiotherapy?

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