Abstract
Objective
To investigate the effect of 16-week home-based physical therapy interventions on
gait and muscle strength.
Design
A single-blinded randomized controlled trial.
Setting
General community.
Participants
Thirty-four older adults (N=34) post hip fracture were randomly assigned to either
experimental group (a specific multi-component intervention group [PUSH], n=17, 10
women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or active control (a non-specific
multi-component intervention group [PULSE], n=17, 11 women, age=77.8±7.8 years, 118.2±37.5
days post-fracture).
Intervention
PUSH and PULSE groups received 32-40 sessions of specific or non-specific multi-component
home-based physical therapy, respectively. Training in the PUSH group focused on lower
extremity strength, endurance, balance, and function for community ambulation, while
the PULSE group received active movement and transcutaneous electrical nerve stimulation
on extremities.
Main Outcome Measures
Gait characteristics, and ankle and knee muscle strength were measured at baseline
and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B)
was measured at baseline.
Results
At 16 weeks, both groups demonstrated significant increases in usual (P<.05) and fast (P<.05) walking speed, while there was no significant difference in increases between
the groups. There was only 1 significant change in lower limb muscle strength over
time (non-fractured side) between the groups, such that PUSH did better (mean: 4.33%,
95% confidence interval:1.43%-7.23%). The increase in usual and fast walking speed
correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.001), respectively.
Conclusion
Gait speed improved in both home-based multicomponent physical therapy programs in
older adults after hip fracture surgery. Muscle strength of the non-fractured limb
improved in the group receiving specific physical therapy training. Specific interventions
targeting modifiable factors such as muscle strength and cognitive performance may
assist gait recovery after hip fracture surgery.
Keywords
List of abbreviations:
CAP (Community Ambulation Project), CAP-MP (Community Ambulation Project—Mechanistic Pathways), CI (confidence interval), PULSE (a non-specific multi-component intervention group), PUSH (a specific multi-component intervention group), 3MS (Modified Mini-Mental State Examination Test), TENS (transcutaneous electrical nerve stimulation), TMT (Trail Making Test)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Recovery from hip fracture in eight areas of function.J Gerontol A Biol Sci Med Sci. 2000; 55: M498-M507
- The impact of decreasing US hip fracture rates on future hip fracture estimates.Osteoporos Int. 2013; 24: 2725-2728
- Physical therapy management of older adults with hip fracture: clinical practice guidelines linked to the international classification of functioning, disability and health from The Academy of Orthopaedic Physical Therapy and The Academy of Geriatric Physical Therapy of The American Physical Therapy Association.J Orthop Sports Phys Ther. 2021; 51 (CPG1-81)
- Effectiveness of supervised home-based exercise therapy compared to a control intervention on functions, activities, and participation in older patients after hip fracture: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2019; 100 (e6): 101-114
- Dynamic principles of gait and their clinical implications.Phys Ther. 2010; 90: 157-174
- The role of executive function and attention in gait.Mov Disord. 2008; 23: 329-342
- Independent domains of gait in older adults and associated motor and nonmotor attributes: validation of a factor analysis approach.J Gerontol A Bio Sci Med Sci. 2012; 68: 820-827
- Identification of gait domains and key gait variables following hip fracture.BMC Geriatr. 2015; 15: 150
- Normative spatiotemporal gait parameters in older adults.Gait Posture. 2011; 34: 111-118
- Effect of a multicomponent home-based physical therapy intervention on ambulation after hip fracture in older adults: the cap randomized clinical trial.JAMA. 2019; 322: 946-956
- Improving community ambulation after hip fracture: protocol for a randomised, controlled trial.J Physiother. 2017; 63: 45-46
- Bone mineral density, soft tissue body composition, strength, and functioning after hip fracture.J Gerontol A Biol Sci Med Sci. 2005; 60: 80-84
- Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable.Stat Methods Med Res. 2016; 25: 1057-1073
- Mild dementia or cognitive impairment: the Modified Mini-Mental State examination (3MS) as a screen for dementia.Can J Psychiatry. 2001; 46: 506-510
- Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry.J Manipulative Physiol Ther. 1987; 10: 172-176
- Gait symmetry measures: a review of current and prospective methods.Biomed Signal Process Control. 2018; 42: 89-100
- Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis.J Biomech. 2006; 39: 2213-2220
- Predictors of gait speed in patients after hip fracture.Physiother Can. 2008; 60: 10-18
- Administration and interpretation of the Trail Making Test.Nat Protoc. 2006; 1: 2277
- When and how should multiple imputation be used for handling missing data in randomised clinical trials–a practical guide with flowcharts.BMC Med Res Methodol. 2017; 17: 162
- The use of predicted confidence intervals when planning experiments and the misuse of power when interpreting results.Ann Intern Med. 1994; 121: 200-206
- Non-discriminant relationships between leg muscle strength, mass and gait performance in healthy young and old adults.Gerontology. 2018; 64: 11-18
- The impact of body composition, pain and resilience on physical activity, physical function and physical performance at 2 months post hip fracture.Arch Gerontol Geriatr. 2018; 76: 34-40
- Inhibition of maximal voluntary contraction force by experimental muscle pain: a centrally mediated mechanism.Muscle Nerve. 2002; 26: 708-712
- Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.JAMA. 2014; 311: 700-708
- Determining meaningful changes in gait speed after hip fracture.Phys Ther. 2006; 86: 809-816
- Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis.Osteoporos Int. 2019; 30: 1371-1381
- Effects of geriatric interdisciplinary home rehabilitation on walking ability and length of hospital stay after hip fracture: a randomized controlled trial.J Am Med Dir Assoc. 2016; 17: e9-e15
- Home rehabilitation after hip fracture: a randomized controlled study on balance confidence, physical function and everyday activities.Clin Rehabil. 2008; 22: 1019-1033
- Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial.J Am Med Dir Assoc. 2015; 16 (350-e1)
- Effects of social group size on information transfer and task allocation.Evol Ecol. 1996; 10: 127-165
- Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review.Br J Sports Med. 2020; 54: 885-891
- Quantitative gait dysfunction and risk of cognitive decline and dementia.J Neurol Neurosurg Psychiatry. 2007; 78: 929-935
- Gait dysfunction in mild cognitive impairment syndromes.J Am Geriatr Soc. 2008; 56: 1244-1251
- Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial.Arch Phys Med Rehabil. 1997; 78: 208-212
- Physical exercise and cognitive performance in the elderly: current perspectives.Clin Interv Aging. 2014; 9: 51
Article info
Publication history
Published online: September 07, 2022
Accepted:
August 22,
2022
Received in revised form:
August 12,
2022
Received:
November 15,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Presented to 2021 Combined Sections Meeting of American Physical Therapy Association online on February 2021, and 98th Annual Conference of American Congress of Rehabilitation Medicine online on September 27, 2021.
This project was supported by the National Institutes of Health (NIH, grants R01AG035009, P30 AG028747, R21 HD043269, R01 AG029315, R37 AG09901, and T32 AG00262). The Advanced Rehabilitation Research and Training Program of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, grant nos. 90AR5028, 90REMM0001) supported the relevant rehabilitation research training of the first author M.H. This material is the result of work supported with resources and the use of facilities at the VA Maryland Health Care System and Baltimore VA Medical Center. The funder played no role in the design, conduct, or reporting of this study.
Clinical Trial Register: ClinicalTrials.gov (NCT01783704).
Disclosures: Dr Mangione is the Data Monitoring Committee member for Pluristem Ltd Dr Magaziner is a member of the Own the Bone Multidisciplinary Advisory Board of the American Orthopedic Association and the Board of the Fragility Fracture Network. Dr Craik is the Member, Board of Trustees, Foundation for Physical Therapy Research. The other authors have nothing to disclose.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
