Mobility training after hip fracture: a randomised controlled trial. Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial. Methodological challenges of multiple-component intervention: lessons learned from a randomized controlled trial of functional recovery after hip fracture. Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials. Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial. Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial. Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fracture: a randomized trial.
to compare the effects of two different exercise programmes after hip fracture.
                assessor-blinded randomised controlled trial.
                hospital rehabilitation units, with continued intervention at home.
                160 people with surgical fixation for hip fracture transferred to inpatient rehabilitation.
                in addition to other rehabilitation strategies, the intervention group received a higher dose (60 min/day) exercise programme conducted whilst standing and the control group received a lower dose exercise programme (30 min/day) primarily conducted whilst seated/supine. The primary outcome measures were knee extensor muscle strength in the fractured leg and walking speed, measured at 4 and 16 weeks.
                150 participants (94% of those recruited) completed the trial. There were no differences between the groups for the two primary outcome measures. Post hoc analyses revealed increased walking speed among those in the higher dose, weight-bearing exercise group with cognitive impairment at 4 and 16 weeks.
                there was no benefit (or harm) due to the higher dose, weight-bearing exercise programme with respect to the primary outcome measures. However, people with hip fracture and cognitive impairment gained greater benefit from the higher dose programme than from the lower dose programme. To compare hospital and home settings for the rehabilitation of patients following hip fracture.
                Randomized controlled trial comparing accelerated discharge and home-based rehabilitation (n = 34) with conventional hospital care (n = 32) for patients admitted to hospital with hip fracture.
                Three metropolitan hospitals in Adelaide, Australia.
                Sixty-six patients with fractured hip.
                Patients assigned to the home-based rehabilitation group were discharged within 48 hours of randomization. The project team therapists made visits to the patient's home and negotiated a set of realistic, short-term and measurable treatment goals with both the patient and carer. Those randomized to usual care remained in hospital for conventional rehabilitation.
                Physical and social dependence, balance confidence, quality of life, carer strain, patient and carer satisfaction, use of community services and incidence of adverse events such as re-admission and falls.
                While there was no difference between the groups for all measures of quality of life, patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from randomization (p < 0.05) and scored higher on the Falls Efficacy Scale (p < 0.05) at four months. There was no difference in falls rates. Patients in the home-based rehabilitation group had a shorter stay in hospital (p < 0.05) but a longer stay in rehabilitation overall (p < 0.001). The groups were comparable on the rate and length of admissions after discharge, use of community services, need for carer input and contact with general practitioner (GP) after discharge.
                This trial further supports the practice of accelerated discharge from hospital and home-based rehabilitation in selected patients recovering from hip fracture. Such a practice appears to improve physical independence and confidence in avoiding subsequent falls which may have implications for longevity and overall quality of life. We conducted a randomized controlled trial to assess the efficacy and safety of a multiple-component intervention designed to improve functional recovery after hip fracture. One hundred seventy-six patients who underwent surgery for a primary unilateral hip fracture were assigned randomly to receive usual care (control arm, n = 86) or a brief motivational videotape, supportive peer counseling, and high-intensity muscle-strength training (intervention arm, n = 90). Between-group differences on the physical functioning, role-physical, and social functioning domains of the SF-36 were assessed postoperatively at 6 months. At the end of the trial, 32 intervention and 27 control patients (34%) completed the 6-month outcome assessment. Although patient compliance with all three components of the intervention was uneven, over 90% of intervention patients were exposed to the motivational videotape. Intervention patients experienced a significant (P = 0.03) improvement in the role-physical domain (mean change, -11 +/- 33) compared to control patients (mean change, -37 +/- 41). Change in general health (P = 0.2) and mental health (P = 0.1) domain scores was also directionally consistent with the study hypothesis. Although our findings are consistent with previous reports of comprehensive rehabilitation efforts for hip fracture patients, the trial was undermined by high attrition and the possibility of self-selection bias at 6-month follow-up. We discuss the methodological challenges and lessons learned in conducting a randomized controlled trial that sought to implement and assess the impact of a complex intervention in a population that proved difficult to follow up once they had returned to the community. To determine whether a home-based systematic multicomponent rehabilitation strategy leads to improved outcomes relative to usual care.
                A randomized controlled trial with 12 months of follow-up.
                General community; 27 home care agencies.
                Three hundred four nondemented persons at least 65 years of age who underwent surgical repair of a hip fracture at two hospitals in New Haven, CT, and returned home within 100 days.
                Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments (physical therapy) and activities of daily living (ADL) disabilities (functional therapy) versus usual care.
                A battery of self-report and performance-based measures of physical and social function.
                There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months (71% vs 75%) or 12 months (74% in both groups) or in home management ADL at 6 months (35% vs 44%) or 12 months (44% vs 48%). There also was no difference between the two groups in social activity levels, two timed mobility tasks, balance, or lower extremity strength at either 6 or 12 months. Compared with participants who received usual care, those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months (p = .04) and a marginally better gait performance (p = .08).
                The systematic multicomponent rehabilitation program was no more effective in promoting recovery than usual home-based rehabilitation. Compared with previous cohorts, however, participants randomized to usual care in our study received more rehabilitative and home care services and experienced a higher rate of recovery. This finding is important given the current pressures to reduce home services. The challenge is to determine the composition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fracture. To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture.
                A randomized controlled trial in patients (n = 199) with femoral neck fracture, aged >or= 70 years.
                The primary outcomes were: living conditions, walking ability and activities of daily living performance on discharge, 4 and 12 months postoperatively. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. A geriatric team assessed those in the intervention group 4 months postoperatively, in order to detect and treat any complications. The control group followed conventional postoperative routines.
                Despite shorter hospitalization, significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups; odds ratios (95% confidence interval (CI) ) 2.51 (1.00-6.30) and 3.49 (1.31-9.23), respectively. More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period, odds ratio (95% confidence interval) 3.01 (1.18-7.61).
                A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture, from both a short-term and long-term perspective. To evaluate the effect of a psychiatric intervention in treating depression (treatment study) and the effect of a psychological treatment in preventing depression (prevention study) after hip fracture in older people.
                Two linked randomized, controlled trials.
                Orthopedic units in Manchester, England.
                Two hundred ninety-three older people who had undergone surgery for a fractured hip: 121 in the treatment study and 172 in the prevention study.
                The Geriatric Depression Scale and Hospital Anxiety and Depression Scale for mood, functional tests for mobility and pain measures.
                There was a slight reduction in depressive symptoms in the active arm of the treatment study. In the prevention study, there was no significant difference in incident depression between the psychological intervention and treatment as usual. There were no differences in the functional and pain outcomes.
                The results from these two randomized, controlled trials show that, after hip fracture surgery, no statistically significant benefits can be achieved from a psychiatric intervention in people who are depressed or a psychological intervention to prevent the onset of depression. To study the feasibility and effect of neuromuscular stimulation on recovery of mobility after surgical fixation for hip fracture.
                Double-blind study with stratified randomization.
                Home-based rehabilitation program.
                Twenty-four women over the age of 75 years with hip fracture.
                Neuromuscular or placebo stimulation of the quadriceps muscle of the fractured leg, applied for 3 hours a day, for 6 weeks, commencing 1 week after surgery.
                Recovery of walking speed and ability, postural stability, lower-limb muscle power, and pain at 7 and 13 weeks after surgery.
                Women in the neuromuscular stimulation group showed faster recovery of mobility. Of the women receiving stimulation, 9 of 12 recovered their prior levels of indoor mobility ability by 13 weeks compared with 3 of 12 in the placebo group (Fisher exact test, P=.046). There were no differences in recovery of walking speed in the first 7 weeks, but women in the stimulation group had greater recovery between 7 and 13 weeks (mean difference=-.13m/s; 95% confidence interval, -.23 to -.01).
                Neuromuscular stimulation at home is feasible and may be effective in speeding recovery of mobility after surgical fixation of hip fracture.
                Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation To determine the effect of a home exercise program on strength, postural control, and mobility following hip fracture.
                Randomized controlled trial of 1 month's duration.
                Daily exercise carried out within the subjects' home environments.
                Forty-two people 64 to 94 years of age, 35 of whom were living independently in the community and 7 of whom were residing in institutional care. Subjects were recruited on average 7 months after a fall-related hip fracture and randomly allocated to either the intervention or the control group (n = 21 each). The groups were well matched in terms of medical conditions, medication use, disability, and activity levels.
                A "home-based" program of weight-bearing exercise established at a visit by a physiotherapist.
                Quadriceps strength, postural sway, functional reach, weight-bearing ability, walking velocity, and self-rated fall risk. The subjects undertook these assessments at the beginning and end of the trial.
                At pretest, exercisers and controls performed similarly in all tests. At the end of the trial, the intervention group showed significantly greater quadriceps strength in the affected (hip-fractured) leg and increased walking velocity. The intervention subjects also improved their weight-bearing ability and reported reduced subjective falls risk. In contrast, there were no significant improvements in any of the test measures in the controls. Within the intervention group, improvements in quadriceps strength were significantly associated with improved performances in the weight-bearing test measures and with increased walking velocity.
                This exercise program improved strength and mobility following hip fracture. Further research is needed to ascertain whether the extent of this improvement in these fall risk factors is sufficient to prevent falls. It is not clear whether occupational therapy is of value for hip fracture patients.
                In a randomized trial we studied the effects of an early, individualized, postoperative occupational training (OT) program on the ability of hip fracture patients to perform ADL and IADL. Secondary endpoints were self-reported fear of pain and pain when performing ADL and IADL. The need for technical aids and/or home adaptations was also investigated. 100 eligible patients (aged > or = 65 years, with independent residence) were randomized 50:50 to an OT or control group (conventional care). During their hospital stay, members of the OT group received individual daily training which included the use of technical aids. Before discharge, the occupational therapist paid a home visit together with the patient. All patients were assessed 2-4 days after surgery, at discharge and after 2 months, using the Klein-Bell ADL scale and a modified version of the Disability Rating Index.
                At discharge, the OT group had better ability to dress, to take care of personal hygiene and bathing activities independently, and to make toilet visits. Age, sex, type of fracture or length of stay at the hospital made no significant contribution to explaining the better ADL ability on discharge. After 2 months, all patients had regained their ADL and IADL abilities. Half of the patients required technical aids and adaptations in their homes.
                Individualized OT-training speed up the ability of patients to perform ADL, thus enhancing the likelihood of patients returning to independent living and reducing the need for postoperative care at home.
There is insufficient evidence from randomised trials to establish the best strategies for enhancing mobility after hip fracture surgery.