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Effects of a home-based physical rehabilitation program on tibial bone structure, density, and strength after hip fracture: a secondary analysis of a randomized controlled trial
Suominen TH, Edgren J, Salpakoski A, Arkela M, Kallinen M, Cervinka T, Rantalainen T, Tormakangas T, Heinonen A, Sipila S
JBMR Plus 2019 Jun;3(6):e10175
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Weight-bearing physical activity may decrease or prevent bone deterioration after hip fracture. This study investigated the effects of a home-based physical rehabilitation program on tibial bone traits in older hip fracture patients. A population-based clinical sample of men and women operated for hip fracture (mean age 80 years, 78% women) was randomly assigned into an intervention (n = 40) and a standard care control group (n = 41) on average 10 weeks postfracture. The intervention group participated in a 12-month home-based rehabilitation intervention, including evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, motivational physical activity counseling, and a progressive, weight-bearing home exercise program comprising strengthening exercises for the lower legs, balance training, functional exercises, and stretching. All participants received standard care. Distal tibia (5% proximal to the distal end plate) compressive bone strength index (BSI; g2/cm4), total volumetric BMD (vBMD-TOT; mg/cm3), and total area (CSA-TOT; mm2), as well as midtibia (55%) strength-strain index (SSI; mm3), cortical vBMD (vBMD-CO; mg/cm3), and ratio of cortical to total area (CSA-CO/CSA-TOT) were assessed in both legs by pQCT at baseline and at 3, 6, and 12 months. The intervention had no effect (group x time) on either the distal or midtibial bone traits. At the distal site, BSI of both legs, vBMD-TOT of the fractured side, and CSA-TOT of the nonfractured side decreased significantly over time in both groups 0.7% to 3.1% (12 months, p < 0.05). At the midshaft site, CSA-CO/CSA-TOT and SSI of both legs, and vBMD-CO of the fractured leg, decreased significantly over time in both groups 1.1% to 1.9% (12 months, p < 0.05). Trabecular and cortical bone traits of the tibia on the fractured and the nonfractured side deteriorated throughout follow-up. The home-based physical rehabilitation intervention aimed at promoting mobility recovery was unable to prevent bone deterioration in older people after hip fracture.

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