Johanna Edgren1, Anu Salpakoski1, Sanna E Sihvonen2, Erja Portegijs1, Mauri Kallinen3, Marja Arkela4, Pirkko Jäntti5, Jukka Vanhatalo4, Mika Pekkonen6, Taina Rantanen1, Ari Heinonen7, Sarianna Sipilä8. 1. Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. 2. JAMK University of Applied Sciences, Jyväskylä, Finland. 3. Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland. 4. Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland. 5. Geriatric Department, Hatanpää City Hospital and School of Medicine, University of Tampere, Tampere, Finland. 6. Peurunka Medical Rehabilitation Center, Laukaa, Finland. 7. Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. 8. Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. Electronic address: sarianna.sipila@jyu.fi.
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 disabilityafter 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).
RCT Entities:
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).
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