Research Seminar: First Presentation of the Hip Fracture RCT Results"Nancy Latham PT, PhD

12:00 pm on Wednesday, November 7, 2012
1:00 pm on Wednesday, November 7, 2012
650 Albany Street- Evans Medical Building Room 714
Background: For many older people, long-term functional limitations persist after formal hip fracture rehabilitation has ended. Intensive, highly supervised exercise programs have been shown to extend the benefits of hip fracture rehabilitation; however, the efficacy of a home exercise program with minimal supervision has not been established. The Aim of this randomized controlled trial was to determine the efficacy of a 6-month home exercise program to improve function after formal hip fracture rehabilitation ended. Methods: 232 functionally limited older adults with recent hip fracture were randomized to exercise or attention control. Functionally-oriented exercises were taught in 3-4 home visits by a physical therapist and performed independently over 6 months. Exercise intensity was progressed using therabands, weighted vests and steps of varying height. Physical function was assessed at baseline and 6 months by blinded assessors using the Short Physical Performance Battery (SPPB) and Activity Measure for Post-Acute Care (AMPAC). All analyses were by intention-to-treat. Results: There were no significant between-group baseline differences or adverse events related to the intervention. Loss to follow-up was 15.9%. As hypothesized, the exercise group showed significant improvement relative to the control group in functional mobility and daily activity functioning at 6 months for all primary endpoints (adjusted analyses (for age, gender and baseline scores): SPPB, P<0.001; AM-PAC Mobility Function P=0.03; AMPAC Daily Activity Function P=0.026). SPPB and AMPAC Daily Activity function scores exceeded minimum clinically important differences. Conclusion: Home-based functionally-oriented exercises successfully extended the functional recovery of older adults who had completed their hip fracture rehabilitation.