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

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。背景：髋部骨折在老年人中很常见，尽管进行了标准的康复治疗，但许多患者无法恢复骨折前的活动或功能状态。目的：确定与低强度家庭运动相比，包括进行性阻力训练在内的扩展门诊康复是否能改善身体虚弱的老年髋部骨折患者的身体功能并减少残疾。设计、环境和患者在1998年8月至2003年5月期间进行了一项随机对照试验，研究对象为90名65岁或以上的社区居民，他们在16周前接受过股骨近端骨折的手术修复，并完成了标准的物理治疗。干预措施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）或家庭运动（n = 44）。主要结局指标：主要结局指标为改进后的身体机能测试（PPT）、功能状态问卷身体机能子量表（FSQ）和日常生活活动量表的总分。次要结果测量是骨骼肌力量、步态、平衡、生活质量和身体组成的标准化测量。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（P = 0.003和P = 0.01）。物理治疗组PPT评分的平均变化（SD）为+6.5（5.5）分（95%可信区间[CI]， 4.6-8.3），对照组PPT评分的平均变化（SD）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）。在肌肉力量、步行速度、平衡和感知健康方面，物理治疗也比对照组有更大的改善，但骨密度或无脂肪量没有改善。结论：在社区居住的老年体弱髋部骨折患者中，与低强度家庭运动相比，6个月的扩展门诊康复包括进行性阻力训练可以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.