Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01783704.

Keywords: Exercise Therapy; Gait; Hip fractures; Muscle strength; Rehabilitation.

Figure 1.

Enrollment, Randomization, and Follow-up of Participants * The present study is an ancillary study of a randomized controlled trial the Community Ambulation Project (CAP) conducted at the University of Maryland Baltimore clinical site (CAP Mechanistic Pathways [CAP-MP]). Eligible hip fracture patients were consented to CAP and then asked to consent for the present CAP-MP study. Completing all CAP assessments was required for enrollment, but individual CAP-MP assessments may have been omitted as the randomization must be conducted within 26 weeks after hospital admission for CAP.