Effects of a Home-Based Physical Rehabilitation Program on Physical Disability After Hip Fracture: A Randomized Controlled Trial

Abstract

Objective

Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture.

Design

Randomized, controlled, parallel-group trial.

Setting

Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital.

Participants

Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups.

Intervention

The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care.

Measurements

Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention.

Results

In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were −0.4 points (SE 0.5), −1.7 (0.7), and −1.2 (0.7) at 3, 6, and 12 months for ADLs and −1.0 (1.2), −3.2 (1.5), and −2.5 (1.4) for IADLs, correspondingly.

Conclusion

The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).