Home-based exercise after hip fracture rehabilitation improves mobility and balance

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1. A home-based exercise program with a physical therapist after hip fracture rehabilitation was associated with significantly improved functional mobility and balance at 6 months. 

2. Beneficial effects of the home-based exercise program persisted at 9-month follow-up. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Long-term rehabilitation after hip fracture is beneficial for regaining functional activity for the elderly, but high costs often make it impractical. In this study, participants who were at least 60 years old with a primary diagnosis of hip fracture that were discharged after acute-care rehabilitation services participated in a 6-month home exercise program. A home-based exercise program without much contact from a physical therapist after hip fracture rehabilitation was associated with significantly improved functional mobility and balance at 6 months. Furthermore, these beneficial effects appeared to persist during follow-up at 9 months, which suggests that these may be long-lasting effects.

Strengths of the study include its follow-up beyond the initial 6 months as well as its prospective randomized design. Limitations include a significant loss of patients to follow-up, which affected outcomes and statistical analysis. The study informs clinical practice by showing the promising possibility that physical therapy at home in the elderly after hip fracture may be a efficacious intervention for patients despite minimal cost, travel, or equipment.

Click to read the study in JAMA

Relevant Reading: Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial

In-Depth [randomized clinical trial]: 232 patients were recruited based on age (>60 years old), diagnosis (primary hip fracture), rehabilitation (discharged from services within 20 months of the study), and function (demonstrating at least one functional limitation) in the greater Boston area. The intervention group (n = 100) received 3 home visits by a physical therapist for training in a home exercise program, and monthly telephone follow-up. The control group (n = 95) received one home visit by dietitians who provided nutrition education for cardiovascular health, as well as phone follow-up. The primary endpoint was function as measured by scores on SPPB12 (assessing balance, gait speed, and chair rise) and AM-PAC (assessing basic mobility and daily activity). At 6 months, the intervention group experienced a significant increase in SPPB scores as the intervention group had scores go from mean score of 6.2 to 7.2, while the control group had SPPB scores go from mean of 6.0 to 6.2 (p<0.001 for intergroup differences). The intergroup differences in the daily activity component of AM-PAC was significantly different in multiple imputation analysis, but not for the mobility component of AM-PAC. Significant associations remained statistically significant at 9 months (similar to 6 months, p<0.05).

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