Context Hip fractures are common in the elderly, and despite standard rehabilitation,
many patients fail to regain their prefracture ambulatory or functional status.
Objective To determine whether extended outpatient rehabilitation that includes
progressive resistance training improves physical function and reduces disability
compared with low-intensity home exercise among physically frail elderly patients
with hip fracture.
Design, Setting, and Patients Randomized controlled trial conducted between August 1998 and May 2003
among 90 community-dwelling women and men aged 65 years or older who had had
surgical repair of a proximal femur fracture no more than 16 weeks prior and
had completed standard physical therapy.
Intervention Participants were randomly assigned to 6 months of either supervised
physical therapy and exercise training (n = 46) or home exercise (control
condition; n = 44).
Main Outcome Measures Primary outcome measures were total scores on a modified Physical Performance
Test (PPT), the Functional Status Questionnaire physical function subscale
(FSQ), and activities of daily living scales. Secondary outcome measures were
standardized measures of skeletal muscle strength, gait, balance, quality
of life, and body composition. Participants were evaluated at baseline, 3
months, and 6 months.
Results Changes over time in the PPT and FSQ scores favored the physical therapy
group (P = .003 and P =
.01, respectively). Mean change (SD) in PPT score for physical therapy was
+6.5 (5.5) points (95% confidence interval [CI], 4.6-8.3), and for the control
condition was +2.5 (3.7) points (95% CI, 1.4-3.6 points). Mean change (SD)
in FSQ score for physical therapy was +5.2 (5.4) points (95% CI, 3.5-6.9)
and for the control condition was +2.9 (3.8) points (95% CI, 1.7-4.0). Physical
therapy also had significantly greater improvements than the control condition
in measures of muscle strength, walking speed, balance, and perceived health
but not bone mineral density or fat-free mass.
Conclusion In community-dwelling frail elderly patients with hip fracture, 6 months
of extended outpatient rehabilitation that includes progressive resistance
training can improve physical function and quality of life and reduce disability
compared with low-intensity home exercise.