Hip fractures are a common problem among older adults, and can have a devastating impact on the ability of older patients to remain independent. A significant functional decline following a hip fracture has been documented, even among individuals who were functioning at high levels before the event. High risk patients include those with deficits in skeletal muscle strength during the post-fracture period. Standard ambulation is achieved with or without an assistive device. However, many patients have persistent strength and mobility deficits at the end of treatment which impair their capacity for independent function, and increase their risk of recurrent falls.
The aim of this study is to evaluate the efficacy of a graduated physical therapy and weight-training program for community-dwelling older post-hip fracture patients who have persistent deficits in mobility, gait and performance of activities of daily living (ADLs) upon completion of standard physical therapy. Participants will be recruited from area hospitals and home care programs to participate in a randomized trial of the intensive exercise program. Screening of participants will begin near the end of their standard physical therapy, and they will enter the program upon completion of therapy. Participants in the intervention group will attend supervised exercise sessions on site, 3 times per week for 6 months. The intensive exercise program consists of 3 months (36 sessions) of flexibility, balance, agility and light resistance exercises, followed by 3 months (36 sessions) of intensive weight training. Subjects in the control group will perform balance and flexibility exercises at home for 3 months. All participants will be evaluated at baseline, 3 months, and 6 months. The primary outcome measure will be performance on an Objective Physical Performance Test. Secondary outcome measures will include measures of skeletal muscle strength, measures of gait and balance, muscle mass of the thigh by MRI, measures of bone quantity and quality by XA and BUA, self-report of performance of ADLs, and measures of quality of life. If successful, such a model of rehabilitation """"""""intensification"""""""" could be applied to outpatient and nursing home settings and targeted at hip fracture patients at high risk for persistent disability and functional decline.
|Herrick, Cynthia; Steger-May, Karen; Sinacore, David R et al. (2004) Persistent pain in frail older adults after hip fracture repair. J Am Geriatr Soc 52:2062-8|