RCT: PRE improves hip fracture outcomes

From my weekly Pubmed update for hip fractures and PT – progressive resistance exercises get better results than e-stim and mental imagery.  Another strike against e-stim vs PRE.

J Am Geriatr Soc. 2010 Oct;58(10):1911-7.

Home-based leg-strengthening exercise improves function 1 year after hip fracture: a randomized controlled study.

Mangione KK, Craik RL, Palombaro KM, Tomlinson SS, Hofmann MT.

From the *Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania; †Department of Physical Therapy, Widener University, Chester, Pennsylvania; and ‡Geriatric Medicine Division, Department of Internal Medicine, Abington Memorial Hospital, Abington, Pennsylvania.

Abstract

OBJECTIVES: To compare the effectiveness of a short-term leg-strengthening exercise program with that of attentional control on improving strength, walking abilities, and function 1 year after hip fracture.

DESIGN: Randomized controlled pilot study.

SETTING: Patients’ homes.

PARTICIPANTS: Community-dwelling older adults (n=26) 6 months after hip fracture at baseline.

INTERVENTION: Exercise and control participants received interventions from physical therapists twice a week for 10 weeks. The exercise group received high-intensity leg-strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery.

MEASUREMENTS: Isometric force production of lower extremity muscles, usual and fast gait speed, 6-minute walk (6-MW) distance, modified Physical Performance Test (mPPT), and Medical Outcomes Study 36-item Short Form Survey (SF-36) physical function.

RESULTS: The primary endpoint was 1 year after fracture. Isometric force production (P=.006), usual (P=.02) and fast (P=.03) gait speed, 6-MW distance (P=.005), and mPPT score (P<.001) were improved 1 year after fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for mPPT score, 0.56 for gait speed, 0.49 for 6-MW, and 0.30 for SF-36 score. More patients in the exercise group made meaningful changes in gait speed and 6-MW distance than control patients (chi-square P=.004).

CONCLUSION: A 10-week home-based progressive resistance exercise program was sufficient to achieve moderate to large effects on physical performance and quality of life and may offer an alternative intervention mode for patients with hip fracture who are unable to leave home by 6 months after the fracture. The effects were maintained at 3 months after completion of the training program.

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