EFFECTS OF EXT OUTPATIENT REHAB AFTER HIP FRACTURE: A RAND CONTROLLED TRIAL

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。内容：髋部骨折在老年人中很常见，尽管进行了标准康复，但许多患者仍无法恢复骨折前的行走或功能状态。目的：确定在身体虚弱的老年髋部骨折患者中，与低强度家庭锻炼相比，包括渐进式阻力训练在内的扩展门诊康复是否改善了身体功能并减少了残疾。设计、设置和患者：1998年8月至2003年5月在90名65岁或65岁以上的社区居民中进行的随机对照试验，这些人在手术修复股骨近端骨折不超过16周之前完成了标准物理治疗。干预参与者被随机分配到6个月的监督物理治疗和运动训练（n = 46）或家庭锻炼（对照条件; n = 44）。主要结局指标：主要结果指标为改良的体能测试（PPT）、功能状态问卷身体功能子量表（FSQ）和日常生活活动量表的总分。次要结果指标是骨骼肌力量、步态、平衡、生活质量和身体成分的标准化指标。在基线、3个月和6个月时对参与者进行评估。结果：PPT和FSQ评分随时间的变化有利于物理治疗组（分别为P = .003和P = .01）。物理治疗组PPT评分的平均变化（SD）为+6.5（5.5）分（95%置信区间[CI]，4.6-8.3），对照组为+2.5（3.7）分（95% CI，1.4-3.6）。物理治疗组FSQ评分的平均变化（SD）为+5.2（5.4）分（95%CI，3.5-6.9），对照组为+2.9（3.8）分（95%CI，1.7-4.0）。物理治疗也有显着更大的改善比控制条件下的措施，肌肉力量，步行速度，平衡，和自觉的健康，但不是骨矿物质密度或无脂肪质量。结论：在社区居住的体弱老年髋部骨折患者中，与低强度家庭锻炼相比，6个月的扩展门诊康复（包括渐进式抗阻训练）可改善身体功能和生活质量，减少残疾。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Context: Hip fractures are common in the elderly, and despite standard rehabilitation, many patients fail to regain their prefracture ambulatory or functional status. Objective: To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture. Design, Setting, and Patients Randomized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed standard physical therapy. Intervention Participants were randomly assigned to 6 months of either supervised physical therapy and exercise training (n = 46) or home exercise (control condition; n = 44). Main Outcome Measures: Primary outcome measures were total scores on a modified Physical Performance Test (PPT), the Functional Status Questionnaire physical function subscale (FSQ), and activities of daily living scales. Secondary outcome measures were standardized measures of skeletal muscle strength, gait, balance, quality of life, and body composition. Participants were evaluated at baseline, 3 months, and 6 months. Results: Changes over time in the PPT and FSQ scores favored the physical therapy group (P = .003 and P = .01, respectively). Mean change (SD) in PPT score for physical therapy was +6.5 (5.5) points (95% confidence interval [CI], 4.6-8.3), and for the control condition was +2.5 (3.7) points (95% CI, 1.4-3.6 points). Mean change (SD) in FSQ score for physical therapy was +5.2 (5.4) points (95% CI, 3.5-6.9) and for the control condition was +2.9 (3.8) points (95% CI, 1.7-4.0). Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength, walking speed, balance, and perceived health but not bone mineral density or fat-free mass. Conclusion: In community-dwelling frail elderly patients with hip fracture, 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise.