title: Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00592813.
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Latham
authors.affiliation: MGH Institute of Health Professions, Boston, Massachusetts.
authors.forename: Bette Ann
authors.initials: BA
authors.lastname: Harris
authors.affiliation: Harvard Medical School, Boston Massachusetts4Spaulding Cambridge Outpatient Center, Cambridge Massachusetts.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Bean
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.affiliation: Spaulding Rehabilitation Network, Boston Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: Goodyear
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Stacey
authors.initials: S
authors.lastname: Zawacki
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Heislein
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Jabed
authors.initials: J
authors.lastname: Mustafa
authors.affiliation: RTI International, Boston Massachusetts.
authors.forename: Poonam
authors.initials: P
authors.lastname: Pardasaney
authors.affiliation: MGH Institute of Health Professions, Boston, Massachusetts.
authors.forename: Marie
authors.initials: M
authors.lastname: Giorgetti
authors.affiliation: Spaulding Cambridge Outpatient Center, Cambridge Massachusetts.
authors.forename: Nicole
authors.initials: N
authors.lastname: Holt
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Lori
authors.initials: L
authors.lastname: Goehring
authors.affiliation: Boston University, Boston, Massachusetts.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jette
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006699:Home Care Services; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome