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 Participants who followed the six-month home
exercise program showed significant improvements in their ability to
get up and around, climb stairs and attend to daily activities,
compared to similar seniors who only had typical post-fracture
rehab.
"We found that a low-contact, low-support sort of program did
significantly improve people's function and mobility six months
after they started it," Nancy Latham told Reuters Health.
Latham is the study's lead author from the Health and Disability
Research Institute at Boston University.
A broken hip often marks the start of a rapid decline in older
people's health.
Latham and her colleagues write in JAMA that previous research has
found about half of men and over a third of women are either living
in a nursing home or dead two years after breaking their hips.
"We know there is a gap there where people are being left in a poor
functional state," Latham said. However, research has also shown
that months of intensive outpatient physical therapy improves
function, mobility and other outcomes, she added.
"It's good to know that works, but that's not going to be
realistic," she said.
To test a more realistic home-based program for helping seniors
regain mobility and function, the researchers recruited 232 people
aged 60 years old and older from the Boston area.
All had experienced a hip fracture and had been released from a
physical rehabilitation program within the past 20 months.
The participants, whose mean age was 78, were then randomly assigned
to one of two groups.
One group of 120 was taught a home exercise program during three or
four visits from a physical therapist. The exercises focused on
realistic daily movements like getting out of a chair and stepping
up or down.
The participants were told to do the exercises three times a week
for six months. They were also given a DVD of the program.
The comparison group of 112 participants received nutrition
education during a home visit and a series of phone calls. They also
received nutrition information through the mail.
Everyone was tested for physical performance, mobility and daily
activity when they entered the study, at six months and again at
nine months.
When they began the program, participants in the exercise group
scored an average of 6.2 on a scale that measures physical
performance between zero and 12 — with higher scores indicating
better function. The nutrition group similarly scored an average of
six at the start.
At six months, the exercise group participants scored an average of
7.2, compared to an average of 6.2 among those in the nutrition
group.
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That 0.8 point difference in function between the two groups
would be a noticeable difference to the participants, according to
the researchers.
The exercise group also improved on measures of mobility and daily
activity, compared to those in the nutrition group. Those
differences, however, would not be as noticeable.
The results were similar three months later, or nine months after
the participants entered the study.
"The message from this study is that if somebody has had a hip
fracture, that when the usual therapy ends, there is most likely
still further where they can improve," she said.
Dr. Stephen Kates, an orthopedic and rehabilitation specialist at
the University of Rochester Medical Center, told Reuters Health it's
important to recognize that not all hip fracture patients are alike.
Kates, who was not involved in the new study, said future research
should focus on which people recovering from a broken hip at home
are the best candidates for this type of exercise.
"It's probably the patient who's a little bit marginal for staying
home," he said, adding that broken hips will become more of a
problem as the population ages.
"It's just going to become more of a problem for our health
system and for all of us to deal with," Kates said.
Latham said the future research on this topic should also integrate
the exercise program into a healthcare system to replicate the
results and see if it prevents people with broken hips from ending
up in nursing homes.
For those who are now recuperating from broken hips, she said they
can seek out guidance from a physical therapist to get as much
support for a home exercise program or additional visits that they
can.
"They will probably see further improvements in their function,"
Latham said. ___
Source: http://bit.ly/1gGP17k
JAMA, online Feb. 18, 2014.
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