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

D Orwig1, K K Mangione2, M Baumgarten1

  • 1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.

Journal of Physiotherapy
|December 15, 2016
PubMed
Summary

This study investigated a targeted physiotherapy program (PUSH) versus a general program (PULSE) for older adults after hip fracture. PUSH aims to improve community ambulation and functional independence more effectively than PULSE.

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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.