TY - JOUR
T1 - Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery
T2 - A Single Site Randomized Trial
AU - Huang, Mei Zhen
AU - Rogers, Mark W.
AU - Pizac, Douglas
AU - Gruber-Baldini, Ann L.
AU - Orwig, Denise
AU - Hochberg, Marc C.
AU - Beamer, Brock A.
AU - Creath, Robert A.
AU - Savin, Douglas N.
AU - Conroy, Vincent M.
AU - Mangione, Kathleen K.
AU - Craik, Rebecca
AU - Zhang, Li Qun
AU - Magaziner, Jay
N1 - Funding Information:
The authors would like to thank Dr Lawrence Magder in the Department of Epidemiology and Public Health at University of Maryland School of Medicine, for his assistance on statistical analysis for the study. This project was supported by the National Institutes of Health (NIH, grants R01AG035009, P30 AG028747, R21 HD043269, R01 AG029315, R37 AG09901, and T32 AG00262). The Advanced Rehabilitation Research and Training Program of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, grant nos. 90AR5028, 90REMM0001) supported the relevant rehabilitation research training of the first author M.H. This material is the result of work supported with resources and the use of facilities at the VA Maryland Health Care System and Baltimore VA Medical Center. The funder played no role in the design, conduct, or reporting of this study.
Funding Information:
This project was supported by the National Institutes of Health (NIH, grants R01AG035009, P30 AG028747, R21 HD043269, R01 AG029315, R37 AG09901, and T32 AG00262). The Advanced Rehabilitation Research and Training Program of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, grant nos. 90AR5028, 90REMM0001) supported the relevant rehabilitation research training of the first author M.H. This material is the result of work supported with resources and the use of facilities at the VA Maryland Health Care System and Baltimore VA Medical Center. The funder played no role in the design, conduct, or reporting of this study.
Publisher Copyright:
© 2022 American Congress of Rehabilitation Medicine
PY - 2023/2
Y1 - 2023/2
N2 - Objective: To investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. Design: A single-blinded randomized controlled trial. Setting: General community. Participants: Thirty-four older adults (N=34) post hip fracture were randomly assigned to either experimental group (a specific multi-component intervention group [PUSH], n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or active control (a non-specific multi-component intervention group [PULSE], n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). Intervention: PUSH and PULSE groups received 32-40 sessions of specific or non-specific multi-component home-based physical therapy, respectively. Training in the PUSH group focused on lower extremity strength, endurance, balance, and function for community ambulation, while the PULSE group received active movement and transcutaneous electrical nerve stimulation on extremities. Main Outcome Measures: Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. Results: At 16 weeks, both groups demonstrated significant increases in usual (P<.05) and fast (P<.05) walking speed, while there was no significant difference in increases between the groups. There was only 1 significant change in lower limb muscle strength over time (non-fractured side) between the groups, such that PUSH did better (mean: 4.33%, 95% confidence interval:1.43%-7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.001), respectively. Conclusion: Gait speed improved in both home-based multicomponent physical therapy programs in older adults after hip fracture surgery. Muscle strength of the non-fractured limb improved in the group receiving specific physical therapy training. Specific interventions targeting modifiable factors such as muscle strength and cognitive performance may assist gait recovery after hip fracture surgery.
AB - Objective: To investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. Design: A single-blinded randomized controlled trial. Setting: General community. Participants: Thirty-four older adults (N=34) post hip fracture were randomly assigned to either experimental group (a specific multi-component intervention group [PUSH], n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or active control (a non-specific multi-component intervention group [PULSE], n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). Intervention: PUSH and PULSE groups received 32-40 sessions of specific or non-specific multi-component home-based physical therapy, respectively. Training in the PUSH group focused on lower extremity strength, endurance, balance, and function for community ambulation, while the PULSE group received active movement and transcutaneous electrical nerve stimulation on extremities. Main Outcome Measures: Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. Results: At 16 weeks, both groups demonstrated significant increases in usual (P<.05) and fast (P<.05) walking speed, while there was no significant difference in increases between the groups. There was only 1 significant change in lower limb muscle strength over time (non-fractured side) between the groups, such that PUSH did better (mean: 4.33%, 95% confidence interval:1.43%-7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.001), respectively. Conclusion: Gait speed improved in both home-based multicomponent physical therapy programs in older adults after hip fracture surgery. Muscle strength of the non-fractured limb improved in the group receiving specific physical therapy training. Specific interventions targeting modifiable factors such as muscle strength and cognitive performance may assist gait recovery after hip fracture surgery.
KW - Exercise Therapy
KW - Gait
KW - Hip fractures
KW - Muscle strength
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85139723801&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2022.08.974
DO - 10.1016/j.apmr.2022.08.974
M3 - Journal article
C2 - 36087806
AN - SCOPUS:85139723801
SN - 0003-9993
VL - 104
SP - 169
EP - 178
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 2
ER -