Timing And Intensity Of Strengthening After Hip Fracture

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DESCRIPTION (provided by applicant): Despite dramatic improvements in medical management of hip fracture, we have been unsuccessful in reducing the significant residual disability that remains in older persons post-fracture. The burgeoning economic cost of this seemingly simple condition and the burden of care borne by caregivers and society are predicted to escalate. Systematic investigations of promising interventions are needed. The interventions should be specific to the deficits that impede recovery, i.e., muscle mass and strength, should be of the correct intensity and be introduced at the most appropriate time to achieve the most beneficial outcome. This planning grant will be used to refine a future trial, a home-based exercise program. The investigators propose to evaluate the intensity and timing of an exercise program to reduce the level of disability post-hip fracture. This planning effort will be used to design a randomized controlled trial (RCT) to compare two different intensities of lower extremity exercise delivered at different times post-fracture to a sham, attention control group. In this future trial the investigators plan to include a broader range of patients with hip fracture than has been included in previous studies instead of focusing only on individuals with the best chance for recovery. They also will document aspects of current rehabilitation care, and identify the factors that predict success of this intervention. The planning project brings together a dynamic group of investigators expert in studying hip fracture outcomes and clinical methodologies. The investigative team consists of experts in hip fracture outcomes, clinical methodologies, and physical intervention required to design and lead a randomized controlled trial of an exercise program following hip fracture. Specific aims of the present application for a planning and development grant are to (1) refine the study design of the future trial; (2) prepare detailed protocols for successful enrollment of subjects in the future trial; (3) establish reliable procedures to ensure treatment adherence; (4) prepare detailed protocols to enable meaningful outcome assessment in the future trial; and (5) develop the future trial budget.