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Home exercises help recovery from a broken hip

By Lilian Anekwe

A study of older people who broke a hip shows that a programme of simple home exercises that focus on everyday tasks can help people to recover better and do more everyday physical tasks after leaving hospital.

What do we know already?

A broken hip is a common injury among older people. There are between 70,000 and 75,000 hip fractures each year in the UK, and this is likely to increase as a result of the ageing population. About half of people who break a hip are able to go home from hospital within 30 days, but it’s common for them to still feel worried about being independent, being able to do everyday things, having a fall, or breaking a hip again.

Most people who are treated in hospital for a broken hip continue to have treatments after they leave, or follow programmes designed to help them avoid falls. These treatments may be based in hospitals, and the most successful tend to be intensive programmes with a lot of supervision from a physiotherapist.

The researchers wanted to know if simpler, home-based exercise programmes would be more suitable than intensive programmes based in hospital for older people or people with other illnesses. This study included 232 people, aged on average 78 years old, who had broken a hip and had already received some physiotherapy before the study started. They all had some physical restrictions on what they could do as a result of the broken hip. People in the study had one of two treatments that each lasted for six months:

  • 120 people followed a home-based therapy programme. This involved four sessions with a physiotherapist who taught them exercises, like standing from a chair or climbing steps, to perform three times a week. The therapists also taught them techniques to help them overcome their fear of falling and encourage them to exercise.

  • 112 people had the same number of training sessions with a dietitian, either in person or by telephone, to learn good nutrition to keep their heart healthy. This was intended as a comparison group.

The researchers compared the results of questionnaires at the start of the study and end of the study, and then again three months after the treatment ended, to see which group was able to do more everyday physical tasks after treatment.

What does the new study say?

After six months of treatment people who followed the home-based exercise programme showed more of an improvement in what they were physically able to do than the group who had sessions with a dietitian.

The home-based therapy group improved by 0.8 points more (on a scale of 0 to 12) than the group who met with a dietitian. This is considered a meaningful improvement in physical ability according to this scale, which measures things like balance, walking speed, and how easily people are able to stand from a chair. Three months after treatment ended people in the home-therapy group were still more physically able than people in the comparison group.

But people who had home-based treatment weren’t any more mobile and didn’t do more physical activity than people in the comparison group at the end of the study, compared with the start.

How reliable is the research?

A problem that could have affected the results in this study is that the researchers didn’t have any information about what type of treatment or physiotherapy people had before the study started, or any other treatment they may have had during the study. This could have made a difference to people’s ability to do physical tasks. Some people did drop out during the study, but the researchers adjusted the calculations to take this into account.

What does this mean for me?

There’s a real need to help people recover well physically from a broken hip to prevent them from having more falls, bone breaks, and complications in future. This study suggests that programmes that focus on daily tasks that people find difficult after breaking a hip, like standing up from a chair or climbing steps, are helpful. They may not help people do more exercise overall, but this could be because many people who break their hip are older or have other illnesses that affect how much exercise they can do. We need more studies to be confident this is an approach that will help people in the long term.

Source:

Latham NK, Harris BA, Bean JF, et al. Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. JAMA. 2014; 311: 700-708.

Feb 18, 2014