Assertive rehabilitation for intracapsular fracture of the proximal femur.
OBJECTIVE
To study the impact of assertive conservative therapy on walking in frail elderly patients with intracapsular fracture of the proximal femaur.


METHODS
Prospective non-randomized controlled trial.


METHODS
Two private geriatric rehabilitation hospitals.


METHODS
From October 1997 to December 2004, 20 patients, not indicated for surgery, were treated with conservative therapy. There were 18 women and 2 men, and their ages were 87.1+/-4.2 (mean +/-SD) years. All of them could walk before hip fracture.


METHODS
Thirteen patients accepted our assertive therapy, which consisted of standing on the fractured limb and walking in parallel bars as soon as possible. Seven patients refused our methods and were conventionally treated; the injured limb was immobilized under skin traction, and then they gradually tried to use a wheelchair for pain reduction.


METHODS
We used the following measures before therapy and six months after: Merle d'Aubigné & Postel's Hip Score, Functional Independence Measure (FIM) and face pain scale.


RESULTS
The two groups were similar demographically. All patients except one (n = 12) responded to our method and could walk. However, the patients treated with the conventional method (n = 7) did not recover the ability to walk. The mean FIM (transfer and locomotion, five items) was 18.2 +/-7.9 points in the former and 9.4 +/- 4.3 points in the latter.


CONCLUSIONS
Assertive rehabilitation was more effective at restoring the ambulatory ability of frail elderly patients with intracapsular fracture of the hip than the conventional method.
Ohsawa
Suguru
S
Department of Rehabilitation Medicine, Osaka Rosai Hospital, Osaka, Japan. sohsawa@orh.go.jp
Miura
Aiko
A
Yagyu
Mie
M
Oizumi
Anzu
A
Yamada
Eiji
E
D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000293:injuries*; D016330:Frail Elderly; D006620:Hip Fractures / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D017746:Joint Capsule; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology