Interventions Used by Physical Therapists in Home Care for People After Hip Fracture (original) (raw)
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Journal of the American Medical Directors Association, 2014
Hip fracture rehabilitation mobility disablement process reenablement a b s t r a c t Objective: To investigate whether a home-based rehabilitation program for community-dwelling older people with recent hip fracture is more effective than standard care in improving mobility recovery and reducing disability. Design: Randomized, controlled, parallel-group trial. Setting: Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. Participants: Clinical population of community-dwelling men and women (aged 60þ) recovering from hip fracture. Participants were randomly assigned into control (n ¼ 41) or intervention (n ¼ 40) groups on average 42 AE 23 days after discharge home. Intervention: A yearlong multicomponent home-based rehabilitation aimed at promoting mobility recovery and physical functional capacity after hip fracture. The intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, a progressive home exercise program, physical activity counseling, and standard care. Measurements: Measurements were outlined according to the tiers of the disablement process, with the ability to negotiate stairs as the main outcome. Prefracture ability to negotiate stairs was enquired at the hospital on average 10 AE 5 days after fracture. Subsequently, current perceived ability to negotiate stairs was reported immediately before the intervention (on average 9 weeks after surgery) and 3, 6, and 12 months thereafter. Other measurements included leg extension power deficit (LEP), functional balance (Berg Balance Scale) and lower extremity performance (Short Physical Performance Battery). Effects of the intervention were analyzed with generalized estimation equations and longitudinal repeated measures mixture path models. Results: The intervention reduced perceived difficulties in negotiating stairs (interaction, group  time P ¼ .001) from prefracture to 12 months compared with the control condition. The mixture path model revealed that less difficulty in negotiating stairs at 6 and 12 months correlated with better functional balance at 3 and 6 months in the intervention group but not controls (group difference P ¼ .007 and P < .001, respectively). Conclusion: The individualized home-based rehabilitation program improved mobility recovery after hip fracture over standard care. To be efficacious in reducing or reversing disability after hip fracture, rehabilitation needs to be individualized, include many components, be progressive, and span a sufficiently long period. Current Controlled Trials (ISRCTN53680197).
Home-Based Exercise and Hip Fracture Rehabilitation
JAMA, 2014
IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended.
JAMA, 2014
IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. INTERVENTIONS The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. MAIN OUTCOMES AND MEASURES Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). RESULTS Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.
Home-Based Exercise and Hip Fracture Rehabilitation—Reply
JAMA, 2014
IMPORTANCE For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. OBJECTIVE To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended.
Archives of Gerontology and Geriatrics, 2018
1-The study was done to investigate whether a postoperative intervention program is effective in reducing mortality and improving mobility in two comparative hip fracture patients over one year postoperatively 2-A controlled trial study with follow up of one hundred twenty four admitted hip fracture patients aged 50 years and older to a Trauma Unit 3-A significant improvement in mobility and reduction of mortality was achieved by the postoperative care program that could be incorporated into the hip fracture patients' care pathway.
Journal of the American Medical Directors Association, 2016
To evaluate if Geriatric Interdisciplinary Home Rehabilitation could improve walking ability for older people with hip fracture compared with conventional geriatric care and rehabilitation. A secondary aim was to investigate the postoperative length of hospital stay (LOS). Randomized controlled trial. Geriatric ward, ordinary housing, and residential care facilities. People operated on for a hip fracture (n = 205), aged 70 or older, including those with cognitive impairment, and living in the north of Sweden. Home rehabilitation with the aim of early hospital discharge that was individually designed and carried out by an interdisciplinary team for a maximum of 10 weeks. Special priority was given to prevention of falls, independence in daily activities, and walking ability both indoors and outdoors. Walking ability and the use of walking device was assessed in an interview during the hospital stay. These assessments were repeated along with gait speed measurements at 3- and 12-month...
Improving community ambulation after hip fracture: protocol for a randomised, controlled trial
Journal of Physiotherapy, 2017
Introduction-After a hip fracture in older persons, significant disability often remains; dependency in functional activities commonly persists beyond 3 months after surgery. Endurance, dynamic balance, quadriceps strength, and function are compromised, and contribute to an inability to walk independently in the community. In the United States, people aged 65 years and older are eligible to receive Medicare funding for physiotherapy for a limited time after a hip fracture. A goal of outpatient physiotherapy is independent and safe household ambulation 2 to 3 months after surgery. Current Medicare-reimbursed post-hip-fracture rehabilitation fails to return many patients to pre-fracture levels of function. Interventions delivered in the home after usual hip fracture physiotherapy has ended could promote higher levels of functional independence in these frail and older adult patients. Primary objective-To evaluate the effect of a specific multicomponent physiotherapy intervention (PUSH), compared with a non-specific multi-component control physiotherapy intervention (PULSE), on the ability to ambulate independently in the community 16 weeks after randomisation.
PM&R, 2009
Objective-The objectives are to describe for the first time a home-based exercise intervention for frail elderly hip fracture patients and to describe the feasibility of this exercise program. Design-A home-based exercise program was used in a randomized controlled trial in which the authors investigated exercise intervention versus no exercise intervention in patients after hip fracture. Setting-This program was implemented at the patients' own home or place of residence after discharge. Participants-Women 65 years of age or older were recruited within 15 days of hip fracture. Eligible patients were those with a nonpathologic fracture who were admitted within 72 hours of injury, had surgical repair of the hip fracture, and met medical inclusion criteria. Participants initially were randomized to exercise groups and then assigned to exercise trainers. Intervention-The exercise contained strength training and aerobic components. Participants were expected to exercise 5 days per week by performing a combination of supervised and independently performed exercise sessions. Intensity and duration were increased gradually by trainers in a standardized way. The frequency of the supervised sessions decreased as participants became more independent. Treatment fidelity visits ensured that the intervention was being delivered as intended across trainers and across participants.