Improving community ambulation after hip fracture: protocol for a randomised, controlled trial.

Area of Science:

• Geriatric rehabilitation
• Orthopedic physiotherapy
• Clinical trial methodology

Background:

• Hip fractures in older adults often lead to persistent disability and reduced functional independence.
• Current rehabilitation programs, including Medicare-funded physiotherapy, frequently fail to restore pre-fracture function.
• Home-based interventions may enhance functional recovery after standard physiotherapy completion.

Purpose of the Study:

• To compare a specific multi-component physiotherapy intervention (PUSH) against a non-specific control intervention (PULSE).
• To evaluate the effect on community ambulation ability 16 weeks post-randomization in older adults following hip fracture.
• To assess long-term functional outcomes and cost-effectiveness.

Main Methods:

• A parallel, two-group randomized controlled trial involving 210 older adults with hip fracture.
• Participants received 16 weeks of home-based physiotherapy (PUSH or PULSE), with assessments at baseline, 16, and 40 weeks.
• PUSH focused on aerobic conditioning and muscle overload; PULSE included TENS, flexibility, and range of motion exercises.

Main Results:

• Primary outcome: community ambulation assessed by the 6-minute walk test (300m+ distance).
• Secondary outcomes included endurance, balance, strength, functional status, quality of life, and cost-effectiveness.
• Intention-to-treat analyses were employed to compare intervention effects.

Conclusions:

• This study is the first to directly compare a targeted home-based physiotherapy intervention (PUSH) with a non-specific one (PULSE) for post-hip fracture recovery.
• The findings will inform the development of more effective rehabilitation strategies for older adults.
• The study will also provide an economic evaluation of the interventions.