Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.
Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.
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DOI：
10.1001/jama.2014.469
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发表时间：
2014-02-19
影响因子：
120.7
通讯作者：
Jette, Alan M.
中科院分区：
文献类型：
--
作者：
Latham, Nancy K.;Harris, Bette Ann;Bean, Jonathan F.;Heeren, Timothy;Goodyear, Christine;Zawacki, Stacey;Heislein, Diane M.;Mustafa, Jabed;Pardasaney, Poonam;Giorgetti, Marie;Holt, Nicole;Goehring, Lori;Jette, Alan M.
对于许多老年人来说，髋部骨折后长期的功能限制仍然存在。在正式髋部骨折康复结束后，在最低限度监督下的家庭锻炼计划的有效性尚未确定。为了确定在正式的髋部骨折康复结束后，与物理治疗师接触最少的家庭锻炼计划是否改善了功能。2008年9月至2012年10月，在232名髋部骨折后完成传统康复的功能受限老年人的家中进行了随机临床试验。干预组(n=120)接受理疗师指导的功能性运动(如从椅子上站立、爬台阶)，并由参与者在家中独立进行6个月。注意对照组(n=112)接受家庭和电话心血管营养教育。在基线、6个月(即干预完成时)和9个月时由盲法评估者评估身体功能。主要结果是6个月后的功能变化，以短身体功能成套测验(SPPB；范围0-12，分数越高表明功能较好)和急性护理后活动能力(AM-PAC)活动度和日常活动(范围23-85和9-101，分数越高表示功能较好)为主要指标。在232名随机患者中，195人在6个月时进行了随访，并进入了初步分析。在功能活动方面，干预组(n=100)较对照组(n=95)有显著改善(干预组平均SPPB评分：基线时6.2[SD，2.7]，6个月时7.2[SD，3]；对照组：基线时6.0[SD，2.8]，6个月时6.2[SD，3]；组间差异：0.8[95%CI，0.4~1.2]，P<；.001；干预组AM-PAC活动度评分：基线时56.2[SD，7.3]，6个月时58.1[SD，7.9]；对照组：基线时56[SD，7.1]，6个月时56.6[SD，8.1]；组间差异1.3[95%CI，0.2~2.4]，P=0.03；干预组AM-PAC日均活动评分：基线时57.4[SD，13.7]，6个月时61.3[SD，15.7]；对照组：基线时58.2[SD，15.2]，6个月时58.6[SD，15.3]；组间差异3.5[95%CI，0.9~6.0]，P=0.03)。在多重归因分析中，SPPB和AM-PAC日常活动的组间差异仍然显著，但对行动能力没有影响。在所有有无补偿的功能测量中，组间差异在9个月内持续存在。在髋部骨折后完成标准康复的患者中，在随机分组后6个月，使用以家庭为基础的以功能为导向的锻炼计划导致身体功能略有改善。这些发现的临床重要性仍有待确定。
For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation. Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined.
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影响因子：
12.7
作者：
Jette, AM;Lachman, M;Krebs, D
通讯作者：
Krebs, D
DOI：
10.1377/hlthaff.2012.1262
发表时间：
2013-05
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Chandra A;Dalton MA;Holmes J
通讯作者：
Holmes J
DOI：
10.1111/j.1532-5415.1996.tb01825.x
发表时间：
1996-06-01
影响因子：
6.3
作者：
Jette, AM;Harris, BA;Levenson, C
通讯作者：
Levenson, C
影响因子：
--
作者：
Orwig, Denise L.;Hochberg, Marc;Magaziner, Jay
通讯作者：
Magaziner, Jay
DOI：
10.1016/j.apmr.2008.02.010
发表时间：
2008-05-01
影响因子：
4.3
作者：
Latham, Nancy K.;Jette, Alan M.;Iezzoni, Lisa L.
通讯作者：
Iezzoni, Lisa L.