title: Effects of a multicomponent home-based physical rehabilitation program on mobility recovery after hip fracture: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate whether a home-based rehabilitation program for community-dwelling older people with recent hip fracture is more effective than standard care in improving mobility recovery and reducing disability.
  
  
  METHODS
  Randomized, controlled, parallel-group trial.
  
  
  METHODS
  Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital.
  
  
  METHODS
  Clinical population of community-dwelling men and women (aged 60+) recovering from hip fracture. Participants were randomly assigned into control (n = 41) or intervention (n = 40) groups on average 42 ± 23 days after discharge home.
  
  
  METHODS
  A yearlong multicomponent home-based rehabilitation aimed at promoting mobility recovery and physical functional capacity after hip fracture. The intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, a progressive home exercise program, physical activity counseling, and standard care.
  
  
  METHODS
  Measurements were outlined according to the tiers of the disablement process, with the ability to negotiate stairs as the main outcome. Prefracture ability to negotiate stairs was enquired at the hospital on average 10 ± 5 days after fracture. Subsequently, current perceived ability to negotiate stairs was reported immediately before the intervention (on average 9 weeks after surgery) and 3, 6, and 12 months thereafter. Other measurements included leg extension power deficit (LEP), functional balance (Berg Balance Scale) and lower extremity performance (Short Physical Performance Battery). Effects of the intervention were analyzed with generalized estimation equations and longitudinal repeated measures mixture path models.
  
  
  RESULTS
  The intervention reduced perceived difficulties in negotiating stairs (interaction, group × time P = .001) from prefracture to 12 months compared with the control condition. The mixture path model revealed that less difficulty in negotiating stairs at 6 and 12 months correlated with better functional balance at 3 and 6 months in the intervention group but not controls (group difference P = .007 and P < .001, respectively).
  
  
  CONCLUSIONS
  The individualized home-based rehabilitation program improved mobility recovery after hip fracture over standard care. To be efficacious in reducing or reversing disability after hip fracture, rehabilitation needs to be individualized, include many components, be progressive, and span a sufficiently long period. Current Controlled Trials (ISRCTN53680197).
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. Electronic address: anu.salpakoski@jyu.fi.
authors.forename: Anu
authors.initials: A
authors.lastname: Salpakoski
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Törmäkangas
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Edgren
authors.affiliation: Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland.
authors.forename: Mauri
authors.initials: M
authors.lastname: Kallinen
authors.affiliation: University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland.
authors.forename: Sanna E
authors.initials: SE
authors.lastname: Sihvonen
authors.affiliation: Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Maija
authors.initials: M
authors.lastname: Pesola
authors.affiliation: Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Vanhatalo
authors.affiliation: Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Arkela
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Rantanen
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Sarianna
authors.initials: S
authors.lastname: Sipilä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000503:physiopathology / Q000534:rehabilitation*; D006699:Home Care Services; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D017063:Outcome Assessment, Health Care
keywords: Hip fracture; disablement process; mobility; reenablement; rehabilitation