Ramadi Ailar, Ezeugwu Victor E, Weber Sydnie, Funabashi Martha, Lima Camila Astolphi, Perracini Monica Rodrigues, Beaupre Lauren A
Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Geriatr Orthop Surg Rehabil. 2022 May 2;13:21514593221090799. doi: 10.1177/21514593221090799. eCollection 2022.
Older adults often experience incomplete recovery after a hip fracture. Rehabilitation programs with progressive resistance training are associated with improved functional recovery. This systematic review and meta-analysis with meta-regression a) evaluated resistance training characteristics reported in hip fracture rehabilitation programs, b) performed meta-analysis of resistance training impact on strength (primary outcome), gait and physical activity (secondary outcomes), and c) explored resistance training program characteristics associated with improved outcomes using meta-regression. Medline, EMBASE, CINAHLPLUS, and Web of Science Core Collection databases were searched (January2000-February2021). Randomized controlled trials including progressive resistance training rehabilitation programs after hip fracture surgery in adults ≥50 years old were included. Meta-analyses and exploratory meta-regression were performed. Meta-analysis showed significant increases in strength (10 trials-728 participants; Standardized Mean Difference (SMD) [95%CI]; .40 [.02, .78]) immediately following program completion in intervention relative to control participants. Meta-analysis on 5 trials (n = 384) with extended follow up found no significant group differences (SMD = .47 [-.28, 1.23]) in strength. Center-based relative to home-based programs were associated with significantly greater improvements in strength ( < .05) as were programs where resistance training intensity was prescribed using one-repetition maximum relative to other exercise prescription methods ( < .05). In gait meta-analysis (n = 10 trials-704 participants), gait speed in intervention participants immediately after the program was significantly higher than control (SMD = .42 [.08, .76]) but this finding was not maintained in extended follow-up (n = 5 trials-240 participants; SMD = .6 [-.26, .38]). Higher resistance training intensity was associated with significant improvements in gait speed ( < .05). No meta-analysis was performed for the 3 heterogeneous studies reporting physical activity. Progressive resistance training improved muscle strength and gait speed after hip fracture surgery in adults ≥50years old immediately after the program ended, but the longer-term impact may be more limited. Higher resistance training intensity and center-based programs may be associated with more improvement, but require further research.
老年人髋部骨折后常经历不完全恢复。进行渐进性抗阻训练的康复计划与功能恢复改善相关。这项系统评价和荟萃分析以及荟萃回归分析：a）评估了髋部骨折康复计划中报告的抗阻训练特征；b）对抗阻训练对力量（主要结局）、步态和身体活动（次要结局）的影响进行了荟萃分析；c）使用荟萃回归分析探索了与改善结局相关的抗阻训练计划特征。检索了Medline、EMBASE、CINAHLPLUS和Web of Science核心合集数据库（2000年1月至2021年2月）。纳入了≥50岁成年人髋部骨折手术后进行渐进性抗阻训练康复计划的随机对照试验。进行了荟萃分析和探索性荟萃回归分析。荟萃分析显示，与对照组参与者相比，干预组参与者在计划完成后立即力量显著增加（10项试验-728名参与者；标准化均数差（SMD）[95%置信区间]；.40[.02，.78]）。对5项延长随访的试验（n = 384）进行的荟萃分析发现，两组在力量方面无显著差异（SMD =.47[-.28，1.23]）。与居家计划相比，基于中心的计划与力量的显著更大改善相关（P <.05），与使用一次重复最大值规定抗阻训练强度的计划相比，与其他运动处方方法相比，也是如此（P <.05）。在步态荟萃分析（10项试验-704名参与者）中，干预组参与者在计划结束后立即的步态速度显著高于对照组（SMD =.42[.08，.76]），但这一发现在延长随访中未得到维持（5项试验-240名参与者；SMD =.6[-.26，.38]）。更高的抗阻训练强度与步态速度的显著改善相关（P <.05）。对3项报告身体活动的异质性研究未进行荟萃分析。≥50岁成年人髋部骨折手术后，渐进性抗阻训练在计划结束后立即改善了肌肉力量和步态速度，但长期影响可能更有限。更高的抗阻训练强度和基于中心的计划可能与更多改善相关，但需要进一步研究。
