Boston University, Boston, Massachusetts.
MGH Institute of Health Professions, Boston, Massachusetts.
JAMA. 2014 Feb 19;311(7):700-8. doi: 10.1001/jama.2014.469.
For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established.
To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended.
DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture.
The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education.
Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function).
Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation.
Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined.
clinicaltrials.gov Identifier: NCT00592813.
对于许多老年人来说，髋部骨折后长期存在功能障碍。在正式髋部骨折康复结束后，进行监督最少的家庭锻炼计划是否能改善功能，尚未得到证实。
确定在正式髋部骨折康复结束后，进行监督最少的家庭锻炼计划是否能改善功能。
设计、设置和参与者：这是一项随机临床试验，于 2008 年 9 月至 2012 年 10 月在 232 名功能受限的老年人的家中进行，这些老年人在髋部骨折后完成了传统康复。
干预组（n=120）接受了由物理治疗师教授的以功能为导向的运动（如从椅子上站起来、爬楼梯），并由参与者在家中独立完成，为期 6 个月。对照组（n=112）接受了家庭和电话心血管营养教育。
由盲法评估者在基线、6 个月（即干预结束时）和 9 个月时评估身体功能。主要结果是 6 个月时功能的变化，通过短体性能电池（SPPB；范围 0-12，得分越高表示功能越好）和活动后护理活动度量（AM-PAC）的移动性和日常活动（范围为 23-85 和 9-101，得分越高表示功能越好）来衡量。
在 232 名随机患者中，有 195 名在 6 个月时进行了随访，并纳入了主要分析。与对照组（n=95）相比，干预组（n=100）在功能移动性方面有显著改善（干预组的 SPPB 平均得分：基线时 6.2 [SD，2.7]，6 个月时 7.2 [SD，3]；对照组：基线时 6.0 [SD，2.8]，6 个月时 6.2 [SD，3]；组间差异：0.8 [95%CI，0.4 至 1.2]，P<.001；干预组 AM-PAC 移动性的平均得分：基线时 56.2 [SD，7.3]，6 个月时 58.1 [SD，7.9]；对照组：基线时 56 [SD，7.1]，6 个月时 56.6 [SD，8.1]；组间差异，1.3 [95%CI，0.2 至 2.4]，P=.03；干预组 AM-PAC 日常活动的平均得分：基线时 57.4 [SD，13.7]，6 个月时 61.3 [SD，15.7]；对照组：基线时 58.2 [SD，15.2]，6 个月时 58.6 [SD，15.3]；组间差异，3.5 [95%CI，0.9 至 6.0]，P=.03）。在多重插补分析中，SPPB 和 AM-PAC 日常活动的组间差异仍然显著，但移动性的组间差异不显著。所有功能测量在随机分组后 9 个月时均存在显著的组间差异，无论是否进行插补。
在髋部骨折后完成标准康复的患者中，使用基于家庭的以功能为导向的锻炼计划可在随机分组后 6 个月时改善身体功能。这些发现的临床重要性仍有待确定。
clinicaltrials.gov 标识符：NCT00592813。
