Department of Rehabilitation, Lolland Municipality, Maribo, Denmark.
Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Denmark.
J Gerontol A Biol Sci Med Sci. 2022 Jul 5;77(7):1455-1462. doi: 10.1093/gerona/glab256.
Recovery of function and regaining muscle strength are challenging after hip fracture. We compared the effectiveness of a 12- versus 6-week outpatient physical therapy program with progressive resistive training (PRT) to increase strength and physical performance.
This parallel, superiority, 2-group randomized controlled trial was conducted in 4 clinics that enrolled community-dwelling, cognitively intact older adults (+60 years) with a surgical repair of a hip fracture and no major medical conditions. Participants received 12 or 6 weeks of PRT and standardized physical therapy, twice weekly. Pain was monitored throughout. Primary outcome was the change in the 6-minute walk test (6MWT) from baseline to 12-week follow-up. Randomization via a computer-generated allocation sequence was implemented using sealed, sequentially numbered opaque envelopes and assessors were blinded to group assignment.
Participants (81% women) with a mean (SD) age of 77 (8.1) years were enrolled at an average of 18 days after hip fracture surgery and randomized into a 12-week group (n = 50) or a 6-week group (n = 50). Mean (SD) change scores in the 6MWT were 143.8 (81.1) and 161.5 (84.1) m in the 12- and 6-week groups, respectively (both exceeding the minimal clinically important difference of 55 m). The mean between-group difference was -17.7 m (95% CI -50.1, 14.8). Pain during training did not exceed moderate levels nor increase as training intensity increased.
Twelve weeks of physical therapy with PRT was not superior to 6 weeks in improving walking distance. Hip fracture-related pain was relatively low and indicated strength testing and training was well tolerated. Clinical Trials Registration Number: NCT01174589.
髋部骨折后，功能恢复和肌肉力量的恢复具有挑战性。我们比较了 12 周与 6 周门诊物理治疗方案联合渐进抗阻训练（PRT）对增加力量和身体表现的效果。
这项平行、优势、2 组随机对照试验在 4 家诊所进行，纳入了接受髋关节骨折手术修复且无重大医疗状况的、居住在社区、认知正常的老年患者（年龄≥60 岁）。参与者接受了 12 或 6 周的 PRT 和标准化物理治疗，每周 2 次。全程监测疼痛。主要结局是从基线到 12 周随访时 6 分钟步行试验（6MWT）的变化。通过使用密封、连续编号的不透明信封的计算机生成分配序列进行随机分组，评估人员对分组分配保持盲态。
髋部骨折手术后平均 18 天入组的患者（81%为女性）平均年龄为 77（8.1）岁，被随机分入 12 周组（n=50）或 6 周组（n=50）。6MWT 的平均（SD）变化评分分别为 12 周组 143.8（81.1）m 和 6 周组 161.5（84.1）m（均超过 55 m 的最小临床重要差异）。组间平均差异为-17.7 m（95%CI，-50.1，14.8）。训练过程中的疼痛未超过中度水平，且随着训练强度的增加而增加。
与 6 周相比，12 周的 PRT 物理治疗并未改善步行距离。髋部骨折相关疼痛相对较低，表明力量测试和训练具有良好的耐受性。临床试验注册号：NCT01174589。
