(RxWiki News) Falls resulting in a hip fracture often occur at home. One new study suggests that the key to a better recovery after such a fall may be found at home as well.
According to the authors of this study, more than 250,000 people fractured their hip last year.
This research team found that patients who received in-home training after regular physical therapy for their hip fracture gained more mobility than those who received standard treatment.
"Discuss any change in exercise after an injury with your doctor."
This study was led by Nancy K. Latham, PhD, PT, of Boston University.
The research team looked at 195 older adults who had completed a standard round of rehabilitation after a hip fracture between September 2008 and October 2010.
The study team broke the patients into two groups. The intervention group received training from a physical therapist to perform functional exercises, like standing from a chair and climbing steps, at home. This training was delivered in home over three visits and included monthly calls to answer questions and a DVD of the program.
The standard care group received in-home and telephone-based cardiovascular nutrition education in a single home visit and was followed by a series of telephone calls and mailing.
The researchers used the Short Physical Performance Battery (SPPB) and the Activity Measure for Post-Acute Care (AM-PAC) to measure each patient’s ability to perform simple functions.
The SPPB rates function on a scale from 0 to 12, with a higher score indicating better function. The range of possible scores for the AM-PAC is 23 to 85 for mobility and 9 to 101 for daily activity, with a higher score indicating better function on both scales.
The data showed both groups started with an average SPPB score of 5.9. After six months, the intervention group had improved to a SPPB score of 7.2 while the standard care group improved to 6.2 overall.
The study also showed additional improvement at the nine-month mark, three months after the active intervention ended. The intervention group continued to improve to 7.6 on the SPPB while the standard care group showed a small increase to 6.3.
The starting data for the intervention group on the AM-PAC was a score of 56.1 for mobility and 57.2 for daily activity. The standard group started at 55.7 for mobility and 58 for daily activity.
The researchers followed up after six months and found that the intervention group increased their AM-PAC scores to 58.1 for mobility and 61.3 for daily activity. The standard group improved to 56.6 for mobility and 58.6 for daily activity.
The study showed an overall greater improvement in patients' basic functions following in-home, monitored exercise compared to the standard medical treatment after hip recovery therapy.
Dr. Latham and colleagues noted that while their findings were clinically important using the SPPB, the AM-PAC numbers failed to meet the criteria predefined by the authors but did remain statistically significant.
These authors said that the traditional approach to rehabilitation for hip fracture leaves many patients with long-term functional limitations that could be reduced with extended rehabilitation, but that this kind of care is unlikely to be used.
Further research is needed to explore whether the interventions in this trial could be used in a cost-effective way in real clinical settings.
According the Dr. Latham and team, this study was limited by a lack of data describing the kind of physical therapy patients received prior to signing up for this study or any additional services or medications they may have received during the trial.
This study was first published on February 18 in the Journal of the American Medical Association (JAMA).
This study was funded the National Institute of Nursing Research.
Co-author Dr. Alan Jette reported holding stock in CREcare LLC, a small business he started that distributes outcome instruments, including the AM-PAC. He also reported receiving royalties from Boston University for instrument licenses.
