Simple at-home exercises could help seniors regain mobility and independence after recovering from a broken hip, according to a new study.
Participants who followed the six-month home exercise program showed significant improvements in their ability to get up and around, climb stairs and attend to daily activities, compared to similar seniors who only had typical post-fracture rehab.
“We found that a low-contact, low-support sort of program did significantly improve people’s function and mobility six months after they started it,” Nancy Latham told Reuters Health.
Latham is the study’s lead author from the Health and Disability Research Institute at Boston University.
A broken hip often marks the start of a rapid decline in older people’s health.
Latham and her colleagues write in JAMA that previous research has found about half of men and over a third of women are either living in a nursing home or dead two years after breaking their hips.
“We know there is a gap there where people are being left in a poor functional state,” Latham said. However, research has also shown that months of intensive outpatient physical therapy improves function, mobility and other outcomes, she added.
“It’s good to know that works, but that’s not going to be realistic,” she said.
To test a more realistic home-based program for helping seniors regain mobility and function, the researchers recruited 232 people aged 60 years old and older from the Boston area.
All had experienced a hip fracture and had been released from a physical rehabilitation program within the past 20 months.
The participants, whose mean age was 78, were then randomly assigned to one of two groups.
One group of 120 was taught a home exercise program during three or four visits from a physical therapist. The exercises focused on realistic daily movements like getting out of a chair and stepping up or down.
The participants were told to do the exercises three times a week for six months. They were also given a DVD of the program.
The comparison group of 112 participants received nutrition education during a home visit and a series of phone calls. They also received nutrition information through the mail.
Everyone was tested for physical performance, mobility and daily activity when they entered the study, at six months and again at nine months.
When they began the program, participants in the exercise group scored an average of 6.2 on a scale that measures physical performance between zero and 12 - with higher scores indicating better function. The nutrition group similarly scored an average of six at the start.
At six months, the exercise group participants scored an average of 7.2, compared to an average of 6.2 among those in the nutrition group.
That 0.8 point difference in function between the two groups would be a noticeable difference to the participants, according to the researchers.
The exercise group also improved on measures of mobility and daily activity, compared to those in the nutrition group. Those differences, however, would not be as noticeable.
The results were similar three months later, or nine months after the participants entered the study.
“The message from this study is that if somebody has had a hip fracture, that when the usual therapy ends, there is most likely still further where they can improve,” she said.
Dr. Stephen Kates, an orthopedic and rehabilitation specialist at the University of Rochester Medical Center, told Reuters Health it’s important to recognize that not all hip fracture patients are alike.
Kates, who was not involved in the new study, said future research should focus on which people recovering from a broken hip at home are the best candidates for this type of exercise.
“It’s probably the patient who’s a little bit marginal for staying home,” he said, adding that broken hips will become more of a problem as the population ages.
“It’s just going to become more of a problem for our health system and for all of us to deal with,” Kates said.
Latham said the future research on this topic should also integrate the exercise program into a healthcare system to replicate the results and see if it prevents people with broken hips from ending up in nursing homes.
For those who are now recuperating from broken hips, she said they can seek out guidance from a physical therapist to get as much support for a home exercise program or additional visits that they can.
“They will probably see further improvements in their function,” Latham said.
SOURCE: JAMA, online February 18, 2014
Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture
Results Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P
< .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation.
Conclusions and Relevance Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined.
JAMA. 2014;311(7):700-708. doi:10.1001/jama.2014.469