Extended rehabilitation programs improve physical function after hip fracture
Extended Exercise Rehabilitation After Hip Fracture Improves Patients' Physical Function: A Systematic Review and Meta-AnalysisPhys Ther. 2012 Nov;92(11):1437-51. doi: 10.2522/ptj.20110274. Epub 2012 Jul 19.
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Mohammad A. Auais (International Centre for Health Innovation, Western University) discusses the effect of extended exercise rehabilitation after hip fracture.
This meta-analysis included 13 randomized controlled trails (1107 fractures) that assessed the effects of an extended exercise rehabilitation program on the physical functioning of patients with hip fractures. The results of the meta-analysis and systematic review indicate that an extended exercise rehabilitation program improves knee extension strength, balance, physical performance based tests, the Timed "Up and Go" test, and fast gait speed when compared with a standard rehabilitation program for patients with hip fractures.
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Hip fractures are the most serious form of osteoporotic fracture. When these fractures are sustained, the goals of treatment include returning patients to a pre-event functional level and preventing recurrent fractures. Unfortunately, only 50% of survivors regain their former levels of mobility. Interest in the effects of an extended rehabilitation period has increased due to the fact that functional status of patients seem to decline after rehabilitation services are stopped. However, the long-term effects of this program are unclear, as findings have been conflicting. This study aimed to determine whether an extended exercise rehabilitation program offered improvement over the regular rehabilitation program with regard to the physical functioning of patients who have undergone surgical repair of a hip fracture.
What was the principal research question?
Does an extended rehabilitation program improve the physical function of patients who have undergone surgical repair of a hip fracture when compared to usual care?
What were the important findings?
- Extended rehabilitation programs significantly improved knee muscle strength on the affected (ES=0.47, 95% CI=0.27 to 0.66, p<0.001) and nonaffected side (ES=0.45, 95% CI=0.16 to 0.74, p=0.002), balance (ES=0.32, 95% CI=0.15 to 0.49, p<0.001), physical performance-based tests (ES=0.53, 95% CI=0.27 to 0.78, p<0.001), timed "Up and Go" test (ES=0.83, 95% CI=0.28 to 1.4, p=0.003), and fast gait speed (ES=0.42, 95% CI=0.11 to 0.73, p=0.008) when compared to standard rehabilitation programs.
- Results from the 6 Minute Walk Test (ES=0.22, 95% CI=0.12 to 0.57, p=0.21), normal gait speed (ES=0.16, 95% CI=0.17 to 0.48, p=0.35), activities of daily living (ES=0.14, 95% CI=0.07 to 0.35, p=0.2), instrumental activities of daily living (ES=0.2, 95% CI=0.07 to 0.48, p=0.14), and the physical function subscale of the 36-Item Short-Form Health Survey (ES=0.2, 95% CI=0.03 to 0.44, p=0.09) were not significantly different between the patients that completed extended rehabilitation programs and the patients that completed standard rehabilitation programs.
What should I remember most?
The data suggests that extended rehabilitation programs result in significantly greater improvement than standard rehabilitation programs with respect to knee muscle strength on the affected and nonaffected side, balance, physical performance-based tests, timed "Up and Go" test, and fast gait speed among patients who required surgical intervention for a fracture of the hip.
How will this affect the care of my patients?
Extended rehabilitation programs may improve physical functioning of the hip when compared to standard rehabilitation programs for hip fractures. However, in order to reach a definite conclusion regarding extended rehabilitation programs, randomized controlled trials with larger sample sizes are required, as well as cost analyses.
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