Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

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• 作者：Anu Salpakoski ; MSc^a ; ^{anu.salpakoski@jyu.fi" class="auth_mail} ; Timo Tö ; rmä ; kangas ; PhD^a ; Johanna Edgren ; MSc^a ; Mauri Kallinen ; MD ; PhD^b ; Sanna E. Sihvonen ; PhD^c ; Maija Pesola ; MD^d ; Jukka Vanhatalo ; MD^e ; Marja Arkela ; PhD^e ; Taina Rantanen ; PhD^a ; Sarianna Sipilä ; PhD^a
• 关键词：Hip fracture ; rehabilitation ; mobility ; disablement process ; reenablement
• 刊名：Journal of the American Medical Directors Association
• 出版年：May 2014
• 年：2014
• 卷：15
• 期：5
• 页码：361-368
• 全文大小：840 K

文摘

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 60+) recovering from hip fracture. Participants were randomly assigned into control (n = 41) or intervention (n = 40) groups on average 42 ± 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 ± 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 = .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 = .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).