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Multicomponent home-based physical therapy versus usual care for recovery after hip fracture
Prasad NK, Bajracharya R, Wijesinha M, Rathbun A, Orwig D, Magder L, Gruber-Baldini A, Mangione K, Craik RL, Magaziner J
Archives of Physical Medicine and Rehabilitation 2023 Dec;104(12):2011-2018
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; 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 quantify the effect of 2 home-based 16-week multi-component physical therapy interventions on functional recovery compared to usual care after hip fracture. DESIGN: Cross-study comparison using participants from the Community Ambulation Project (CAP; a randomized controlled trial) were compared to the Baltimore Hip Studies-seventh cohort (BHS-7; an observational cohort study) at 3 different time points (CAP 15, 31, 55 weeks; BHS-7 8, 26, and 52 weeks). SETTING: General community PARTICIPANTS: Combined convenience sample of hip-fracture patients 8 to 26 weeks post admission from a prospective cohort study and randomized controlled trial. (n = 549) INTERVENTIONS: CAP participants were randomized to one of 2 interventions (PUSH: specific multi-component intervention; PULSE: non-specific multi-component intervention) after standard rehabilitation; BHS-7 participants received usual care. MAIN OUTCOME MEASURES: Mean function (as measured by Short Physical Performance Battery (SPPB) and gait speed) was estimated in each cohort as quadratic functions of time using data from 3 post-fracture assessments in both studies (CAP 15, 31, 55 weeks; BHS-7 8, 26, and 52 weeks). RESULTS: The harmonized samples included 101 PUSH, 100 PULSE, and 128 BHS-7 participants that had different demographic and clinical characteristics. Mean baseline SPPB scores (meters per second) were PUSH 5.5 (SD 2.2), PULSE 5.5 (SD 2.4), and BHS-7 4.6 (SD 2.5); and mean gait speeds were 0.60 m/s (SD 0.20) for PUSH, 0.59 m/s (SD 0.17) for PULSE, and 0.46 m/s SD (0.21) for BHS-7, respectively. Estimated between-group differences for SPPB improvement from 75 days to 1-year post admission were 0.7 (p = 0.04) in PUSH versus BHS-7; and 0.9 (p = 0.01) in PULSE versus BHS-7. Mean differences in change in gait speed were 0.08 (p = 0.002) for PUSH versus BHS-7; and 0.06 (p = 0.02) PULSE versus BHS-7 (p = 0.02). CONCLUSIONS: Findings from this cross-study comparison that combined participants from 2 separate studies, with different designs and samples, suggest that home-based multi-component physical therapy programs were associated with greater functional improvement after hip fracture compared to usual care.

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