An at-home exercise program modestly improved function and mobility in hip fracture patients, a recent study found.
The trial included 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture between 2008 and 2012. They were randomized to either a 6-month exercise program taught in their homes by a physical therapist or a control program of in-home and telephone-based cardiovascular nutrition education. The exercise program focused on functionally oriented exercises, such as standing from a chair and climbing a step, and included no more than 4 visits from the physical therapist.
Patients' physical function was measured at baseline, 6 months and 9 months, and results were published in the Feb. 19 Journal of the American Medical Association.
At both 6- and 9-month assessments, the intervention group had clinically significant improvements in functional mobility compared to controls, as measured by the Short Physical Performance Battery. When assessed with the Activity Measure for Post-Acute Care instrument, the difference between groups was also statistically significant but did not meet the study's prespecified standard for clinical significance.
The study measured function using both patient-reported and physical performance measures, and while home exercise improved both types, the differences were greater in the performance-based measures, the researchers noted. “This finding suggests that it may be easier to improve a person's capacity to function than to change their actual level of function in daily life in the face of significant comorbidities,” the authors said.
The most effective way to improve long-term functional outcomes for hip fracture patients would be extended rehabilitation, the authors noted, but costs are prohibitive, so patients are typically discharged from therapy with a written home exercise program. This study provides an alternative middle strategy, which gives patients more guidance on their at-home exercise. Future research should evaluate the cost-effectiveness of such a system in clinical practice, the authors concluded.