Home-based exercise program improves physical function in patients with hip fractures

The use of a home-based functionally oriented exercise program among patients who had completed standard rehabilitation after hip fracture resulted in modest improvement in physical function at 6 months follow-up.

“The traditional approach to rehabilitation for hip fracture leaves many patients with long-term functional limitations that could be reduced with extended rehabilitation. However, it is unlikely that additional months of highly supervised rehabilitation can be provided to patients with hip fracture,” Nancy K. Latham, PhD, PT, and colleagues wrote in the study.

Researchers randomly assigned 232 functionally limited older adults who completed traditional rehabilitation after a hip fracture to an intervention group who underwent a home exercise hip rehabilitation program. A physical therapist taught functionally oriented exercises, such as standing from a chair and climbing a step. Patients performed the exercises independently in their homes for 6 months and received in-home and telephone-based cardiovascular nutrition education.

Researchers assessed physical function at baseline, 6 months and 9 months. Primary outcome measures included change in function at 6 months measured by the Short Physical Performance Battery (SPPB) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity.

By 6 months, 195 patients were followed up and included in the primary analysis. Researchers found that the intervention group had significant improvement relative to the control group in functional mobility. Between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. However, researchers found significant between-group differences persisted at 9 months for all functional measures with and without imputation.

“Exercise programs are challenging for people to perform on their own without clear feedback about whether they are performing the exercises accurately and safely and without guidance as to how to change the exercises over time. The findings from our study suggest that [the approach used in this study] could be introduced to patients after completion of traditional physical therapy following hip fracture and may provide a more effective way for these patients to continue to exercise in their own homes. However, future research is needed to explore whether the interventions in this trial can be disseminated in a cost-effective manner in real clinical environments.”

Reference:

Latham NK. JAMA. 2014;doi:10.1001/jama.2014.469.

Disclosure: Latham has no relevant financial disclosures.