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A multi-component home-based physical therapy program is effective in helping older adults regain their ability to walk after a hip fracture, but the improvement may not be enough for them to ambulate independently in the community, according to a study published this month in JAMA.

For the multi-center study, researchers at Arcadia University, UConn Health at the University of Connecticut, and the University of Maryland School of Medicine evaluated 2 different home-based rehabilitation programs designed to address specific walking-related abilities such as endurance, balance, strength, and lower extremity function.

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They enrolled 210 patients age 60 years and older who were recovering from non-pathologic, minimal trauma hip fractures that required surgical fixation. Patients were included if they:

• Had been living in the community prior to the fracture
• Had been able to walk without human assistance for the 2 months before the fracture
• Were unable to walk without human assistance during daily activities at the time of enrollment

Study participants were randomized to 1 of 2 home-based programs:

• Active treatment: Aerobic, strength, and balance training (n=105)
• Active control group: Nerve stimulation and active range-of-motion (ROM) exercises for the upper and lower extremities (n=105)

In addition, patients in both groups received up to 3 home visits from a physical therapist each week (60 minutes per visit) over the 16-week study period. They also received nutritional counseling and daily vitamin D (2000 IU), calcium (600 mg), and multivitamin supplements.

The primary study outcome at 16 weeks was the ability to walk 300 meters or more – approximately the length of 3 football fields – in 6 minutes, or roughly the minimum distance a person would have to walk to perform activities in the community such as crossing the street at a traffic light.

Only 23% of participants in the group that received aerobic, strength, and balance training could walk more than 300 meters in 6 minutes. In the group that received nerve stimulation and ROM exercises, 18% of participants could walk 300 meters or more in 6 minutes, a difference that was not statistically significant.

“Many older adults face challenges regaining mobility after hip fracture. We were pleased that in this study, a sizeable number of participants achieved community ambulation capacity,” said Richard Fortinsky, PhD, Professor and Health Net, Inc. Endowed Chair in Geriatrics and Gerontology at UConn Health.

“However, much more needs to be done to develop and carry out targeted and creative rehabilitation programs that will benefit greater numbers of older adults who strive to become community ambulators following hip fracture.”

Going forward, this research could help shed light on ways to improve home-based interventions. For example, future research could assess the influence of factors such as the amount of exercise, how well patients adhere to the treatments, behavior and environmental factors, and body composition in response to in-home interventions.

Sources

Magaziner JS, Mangione KK, Orwig D, et al. Effect of a multicomponent home-based physical therapy intervention on ambulation after hip fracture in older adults: the CAP randomized clinical trial. JAMA. 2019 Sep 10;322(10):946-956. doi: 10.1001/jama.2019.12964.

Magaziner JS. Improving Community Ambulation After Hip Fracture (CAP). ClinicalTrials.gov identifier (NCT number): NCT01783704. Accessed September 17, 2019.