Section 3: Exercise after a hip fracture Copy

In Your Manual

Basics: Page 192-193 | Clinical: Page 208-209

A recent Cochrane review of mobilization strategies post osteoporotic hip-fracture suggested (Hadoll, 2007):

There is insufficient evidence overall to establish the effectiveness of the reviewed mobilization strategies used in rehabilitation after hip fracture surgery (including physiotherapy, treadmill, resistance training & electrical stimulation)
Limited number of trials, limited power
Little information about persistence

Two positive RCT studies (Binder et al., 2004; Hauer et al., 2002):

Concluded that improved mobility occurred with intensive, supervised ongoing exercise/therapy, specifically with significant differences between the exercise and control groups in the following measurements:

Improved walking velocity
Less need of walking aid
Improved measures on the Physical Performance Test
Improved Stair climbing
Increased leg extensor strength, decreased fear of falling, improved balance
Interestingly, no change in BMD was found

What were the characteristics of these two positive trials?

Exercise was prescribed for 3x/wk for 3 months or 6 months

Patients were supervised in an outpatient centre, using machines
Progressive resistive training at 70-90% or 65% max
Included functional training – walking, stepping, balance activities

CASEINPOINT1_positive trials for hip rehab

More recent work has revealed:

Higher intensity, weight-bearing exercise are not better than lower intensity seated or lying exercises for mobility and balance (Moseley et al., 2009)
Increased muscle strength and power with 2x/wk supervised resistance training for 12 wks (Portegijs et al., 2008)
Arm ergometry + inpatient rehabilitation improved aerobic fitness, mobility and balance (Mendelsohn et al., 2008)

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References

Binder E.F., Brown, M., Sinacore, D.R., Steger-May, K., Yarasheski, K.E., Schechtman, K.B. (2004).Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial.JAMA, 292 (7), 837-46.

Handoll, H.H., Sherrington, C. (2007). Mobilisation strategies after hip fracture surgery in adults.Cochrane Database Syst Rev, 24; (1):CD001704

Hauer, K. Specht, N., Schuler, M., Bartsch, P., Oster, P. (2002). Intensive physical training in geriatricpatients after severe falls and hip surgery. Age Ageing, 31(1): 49-57.

Mendelsohn, M.E., Overend, T.J., Connelly, D.M., Petrella, R.J. (2008). Improvement in aerobic fitnessduring rehabilitation after hip fracture. Arch Phys Med Rehabil, 89(4): 609-17.

Moseley, A.M., Sherrington, C., Lord, S.R., Barraclough, E., St George, R.J., Cameron, I.D.(2009). Mobility training after hip fracture: a randomized controlled trial. Age Ageing, 38(1): 75-80.

Portegijs, E., Kallinen, M., Rantanen, T., Heinonen, A., Sihvonen, S., Alen, M., Kiviranta, I., Sipila, S. (2008). Effects of resistance training on lower-extremity impairments in older people with hip fracture. Arch Phys Med Rehabil, 89(9): 1667-74