Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta; Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä.
Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta; Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä.
Arch Phys Med Rehabil. 2021 Sep;102(9):1692-1699. doi: 10.1016/j.apmr.2021.04.004. Epub 2021 Apr 30.
OBJECTIVE: To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures. DESIGN: Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up. SETTING: Home-based intervention. PARTICIPANTS: Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups. INTERVENTIONS: Supervised physical exercise twice a week. MAIN OUTCOME MEASURES: The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. RESULTS: Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group. CONCLUSIONS: Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.
目的：评估一项身体锻炼计划对髋部骨折患者居家天数、医疗保健和社会服务使用和成本、死亡率以及功能独立性的影响。
设计：采用平行 2 组设计的随机对照试验，包括 12 个月的干预和 12 个月的登记随访。
设置：家庭为基础的干预。
参与者：年龄≥60 岁（N=121）、接受过髋关节手术且居家的髋部骨折患者，随机分为身体锻炼组（n=61）和常规护理组（n=60）。
干预措施：每周两次监督身体锻炼。
主要观察指标：主要结局是 24 个月内的居家天数。次要结局是医疗保健和社会服务的使用和成本、24 个月内的死亡率以及 12 个月内的功能独立性测量（FIM）。
结果：在 24 个月内，两组在居家天数（发病率比，1.01；95%置信区间[CI]，0.90-1.14）或死亡率（风险比，1.01；95% CI，0.42-2.43）方面无显著差异。两组的医疗保健和社会服务总费用无差异。身体锻炼组的人均年费用比常规护理组高 1.26 倍（95% CI，0.87-1.86），12 个月时高 1.08 倍（95% CI，0.77-1.70），24 个月时高 1.08 倍（95% CI，0.77-1.70）。两组在 12 个月时 FIM 变化的平均差异为 4.5 分（95% CI，0.5-8.5；P=.029），身体锻炼组更有利。
结论：长期居家身体锻炼对髋部骨折患者 24 个月内的居家天数没有影响。在这 24 个月内，干预的成本是中性的。两组在 12 个月时 FIM 评分均有所提高，但身体锻炼组的改善明显大于常规护理组。
J Physiother. 2016-10-28
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