Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial

Johanna Edgren, Anu Salpakoski, Sanna E Sihvonen, Erja Portegijs, Mauri Kallinen, Marja Arkela, Pirkko Jäntti, Jukka Vanhatalo, Mika Pekkonen, Taina Rantanen, Ari Heinonen, Sarianna Sipilä
Journal of the American Medical Directors Association 2015, 16 (4): 350.e1-7

OBJECTIVE: Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture.

DESIGN: Randomized, controlled, parallel-group trial.

SETTING: Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital.

PARTICIPANTS: Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups.

INTERVENTION: The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care.

MEASUREMENTS: Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention.

RESULTS: In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were -0.4 points (SE 0.5), -1.7 (0.7), and -1.2 (0.7) at 3, 6, and 12 months for ADLs and -1.0 (1.2), -3.2 (1.5), and -2.5 (1.4) for IADLs, correspondingly.

CONCLUSION: The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).


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