title: Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial.
abstract: OBJECTIVE
  Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture.
  
  
  METHODS
  Randomized, controlled, parallel-group trial.
  
  
  METHODS
  Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital.
  
  
  METHODS
  Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups.
  
  
  METHODS
  The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care.
  
  
  METHODS
  Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention.
  
  
  RESULTS
  In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were -0.4 points (SE 0.5), -1.7 (0.7), and -1.2 (0.7) at 3, 6, and 12 months for ADLs and -1.0 (1.2), -3.2 (1.5), and -2.5 (1.4) for IADLs, correspondingly.
  
  
  CONCLUSIONS
  The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).
authors: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors: Johanna
authors: J
authors: Edgren
authors: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors: Anu
authors: A
authors: Salpakoski
authors: JAMK University of Applied Sciences, Jyväskylä, Finland.
authors: Sanna E
authors: SE
authors: Sihvonen
authors: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors: Erja
authors: E
authors: Portegijs
authors: Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland.
authors: Mauri
authors: M
authors: Kallinen
authors: Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
authors: Marja
authors: M
authors: Arkela
authors: Geriatric Department, Hatanpää City Hospital and School of Medicine, University of Tampere, Tampere, Finland.
authors: Pirkko
authors: P
authors: Jäntti
authors: Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
authors: Jukka
authors: J
authors: Vanhatalo
authors: Peurunka Medical Rehabilitation Center, Laukaa, Finland.
authors: Mika
authors: M
authors: Pekkonen
authors: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors: Taina
authors: T
authors: Rantanen
authors: Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors: Ari
authors: A
authors: Heinonen
authors: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. Electronic address: sarianna.sipila@jyu.fi.
authors: Sarianna
authors: S
authors: Sipilä
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D063868:Patient Outcome Assessment; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: ADL; IADL; proximal femoral fracture