Case report: an evidence-based approach to examination and intervention following hip fracture

A majority of older adults with hip fracture retain longstanding disabilities following surgery. Research suggests that more aggressive treatment techniques can improve outcome. The purpose of this case report is to describe an evidence-based approach to guide physical therapy examination and intervention for a woman with significant frailty recovering from hip fracture.

The patient is a 97-year-old woman residing in a skilled nursing facility 3 months status-postsurgical repair of an intertrochanteric hip fracture. She had received 2 1/2 months of physical therapy care using conventional interventions, however, had not regained her prefracture mobility status. She agreed to participate in a progressive high-intensity resistance training program over a 2-month period to augment her lower-extremity strength and function. The 5-day training regimen emphasized resistance training with a weighted belt twice-weekly with endurance and balance training interposed on nonstrength training days. The patient's goal was to return to community dwelling.

Lower-extremity isometric force was measured using handheld dynamometry. Functional mobility was assessed via Timed Up and Go, Six-Minute Walk, Berg Balance, and gait speed tests. A 9-item Physical Performance Test gauged degree of frailty.

Hip extension, hip abduction, and knee extension isometric force scores on the involved lower-extremity increased by 8 kg, 3 kg, and 7 kg, respectively. Balance, frailty, and gait speed indices improved from 14 to 45, 8 to 18, and 0.50 to 0.83 m/s, respectively.

Prescribed high-intensity resistance training was used to improve the patient's functional status 2 months after completing a conventional physical therapy program.