Extended rehab after hip fracture can improve function

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In elderly patients with hip fracture, six months of outpatient rehabilitation and progressive resistance training is better than home exercise in improving physical performance and mobility and reducing disability, according to researchers at Washington University School of Medicine in St. Louis.

“Our findings raise a question about whether the current practice of discontinuing physical therapy at the conclusion of home treatment is sufficient for this high-risk population,” Dr. Ellen F. Binder and her team suggest in the Journal of the American Medical Association.

The study included 90 patients, age 65 or older, who had undergone surgical repair of a hip fracture and had completed standard physical therapy.

Forty-six subjects were randomly assigned to six months of supervised physical therapy that included whole-body progressive resistance exercise training. Forty-four were randomly assigned to low-intensity home exercise that focused primarily on flexibility.

The researchers found that physical performance and function status scores were higher in the physical therapy group than in the home exercise group.

Comparisons between prefracture and six-month activities of daily living (ADL) scores indicated a decline for the home exercise group and a return toward prefracture levels in the physical therapy group, the authors note.

“Our findings suggest that elderly hip fracture patients who respond positively to home physical therapy but have persistent ADL and mobility impairments should be referred to outpatient rehabilitation facilities on discharge from their home program,” Binder and her associates maintain.

However, “a change in Medicare policy may be necessary to implement this type of protocol for a treatment period of up to six months,” they add.

SOURCE: Journal of the American Medical Association, August 18, 2004.

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