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Effect of multicomponent home-based training on gait and muscle strength in older adults after hip fracture surgery: a single site randomized trial
Huang MZ, Rogers MW, Pizac D, Gruber-Baldini AL, Orwig D, Hochberg MC, Beamer BA, Creath RA, Savin DN, Conroy VM, Mangione KK, Craik R, Zhang L-Q, Magaziner J
Archives of Physical Medicine and Rehabilitation 2023 Feb;104(2):169-178
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. DESIGN: A single-blinded randomized controlled trial. SETTING: General community. PARTICIPANTS: Thirty-four older adults (N = 34) post hip fracture were randomly assigned to either experimental group (a specific multi-component intervention group (PUSH), n = 17, 10 women, age 78.6 +/- 7.3 years, 112.1 +/- 39.8 days post-fracture) or active control (a non-specific multi-component intervention group (PULSE), n = 17, 11 women, age 77.8 +/- 7.8 years, 118.2 +/- 37.5 days post-fracture). INTERVENTION: PUSH and PULSE groups received 32 to 40 sessions of specific or non-specific multi-component home-based physical therapy, respectively. Training in the PUSH group focused on lower extremity strength, endurance, balance, and function for community ambulation, while the PULSE group received active movement and transcutaneous electrical nerve stimulation on extremities. MAIN OUTCOME MEASURES: Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. RESULTS: At 16 weeks, both groups demonstrated significant increases in usual (p < 0.05) and fast (p < 0.05) walking speed, while there was no significant difference in increases between the groups. There was only 1 significant change in lower limb muscle strength over time (non-fractured side) between the groups, such that PUSH did better (mean 4.33%, 95% confidence interval 1.43% to 7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r = -0.371, p = 0.037) and improved muscle strength in the fractured limb (r = 0.446, p = 0.001), respectively. CONCLUSION: Gait speed improved in both home-based multicomponent physical therapy programs in older adults after hip fracture surgery. Muscle strength of the non-fractured limb improved in the group receiving specific physical therapy training. Specific interventions targeting modifiable factors such as muscle strength and cognitive performance may assist gait recovery after hip fracture surgery.

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