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• W2498329431 abstract "To the Editor: The clinical and scientific communities have acknowledged the importance of adequately targeted rehabilitation after hip fracture, but best practices for mobility recovery have not been determined.1 Rehabilitation programs that take into account differences in the health and functioning of individuals with hip fracture need to be developed and studied. The primary results of a randomized controlled trial (ISRCTN53680197) showed that a yearlong Promoting Mobility (ProMo) rehabilitation program reduced perceived difficulties in mobility more than standard care alone.2 Moreover, better physical functional capacity after 3 and 6 months of the ProMo intervention correlated with fewer mobility difficulties at 1 year than with standard care.2 These associations led to the hypothesis that only individuals with sufficient physical functional capacity and mobility to start with can attain broader intervention-induced mobility benefits. The purpose of this secondary subgroup analysis was to investigate whether the effects of ProMo on physical functional capacity and mobility differed according to level of prefracture and postdischarge mobility. Community-dwelling participants aged 60 and older who underwent surgery for hip fracture (N = 81) were randomized to ProMo (n = 40) or a standard care control group (n = 41).2 For this subgroup analysis, participants were categorized as having moderate (MMD; intervention n = 23, control n = 27) or severe (SMD; intervention n = 17, control n = 14) mobility difficulty based on perceived difficulty walking outdoors before their fracture, at discharge, and on average 6 weeks after discharge.3 The ethical committee of the Central Finland Health Care District approved the study. Physical functional capacity was assessed according to the Short Physical Performance Battery (SPPB)4 and the Berg Balance Scale (BBS).5 Mobility was assessed according to the Timed Up-and-Go (TUG) test6 and 10-m maximum walking speed test. The intervention group participated in the ProMo program in addition to receiving standard care. ProMo was an individually customized yearlong intervention implemented in participants’ homes. It included an evaluation and modification of environmental hazards, guidance for safe walking, a progressive home exercise program, and motivational physical activity counseling. Participants kept an exercise diary and estimated their rate of perceived exertion (RPE; range 6–20)7 during training sessions. Intervention adherence was calculated as (number of exercises performed):(expected number of exercises) × 100%. Mean RPE during each training session was calculated, and the resulting time series data for participants with MMD and SMD were compared using the Chow test. Linear models for outcomes were used to estimate expected means and variances at each time-point for each group. Contrasts were constructed for group comparisons of each time-point relative to baseline and for linear trend over time. Unconstrained covariance matrix was specified for longitudinal outcome measurements. Adherence to the intervention was similar in both groups (P = .24–.89 for the various exercises). For the strength, balance, and functional exercises, mean weekly RPE varied from 10 to 13 (light to somewhat hard), with no significant differences between participants with MMD and SMD (P = .10 to >.99). Six of the ProMo participants with MMD were suspended for medical reasons (pneumonia and new hip fracture, cerebral infarction, urinary tract infection, sacrum strain fracture, revision operation, new hip fracture); two returned to the intervention. Three participants with SMD were suspended for medical reasons (pubic bone fracture, pulmonary embolism, cardiac failure). One participant with MMD died from cardiac failure before the 12-month assessment. Of participants with MMD, those in the ProMo program had significantly greater improvement on the SPPB, TUG, and BBS than controls (Table 1). A significant intervention effect was observed after 3 months of the intervention in SPPB and BBS scores. In participants with SMD, ProMo had no significant effect on any of the outcomes. The ProMo restored physical functional capacity and mobility in participants with MMD in a clinically meaningful way. An increase of 0.4–1.5 points on the SPPB has been shown to substantially reduce incident mobility disability.8 Moreover, improvement in BBS score of 5.6 points and exceeding the cut-point of 45 may decrease the future risk of falls. It is possible that the intervention was too demanding for those with SMD, because their results were not different from the results of controls. In an earlier study that compared individuals with MMD and SME, a greater proportion of those with SMD had movement-related offending pain in the fractured limb and had fallen indoors during the year before the fracture.3 In addition, a 90% of participants with SMD and 68% with MMD used a walking aid outdoors. These factors may have made it more difficult for those with SMD to perform the exercises, because the exercises were mostly performed under weight-bearing conditions. To support functioning and participation in the community, it is likely that older adults with SMD need a comprehensive geriatric intervention and care after hip fracture. This study was supported by the nonprofit research funding organizations the Social Insurance Institution of Finland (Grant Dnro 24/26/2007) and the Finnish Ministry of Education and Culture (Grants Dnro 43/627/2007, 63/627/2008, 79/627/2009). Conflict of Interest: The authors declare no competing interests. Author Contributions: Sipilä: study concept and design, overall execution of project, analysis of data, interpretation of results, writing the manuscript. Salpakoski: study design, participant recruitment, data collection, interpretation of results, critical review and approval of manuscript. Edgren: data collection, supervision of intervention, interpretation of results, critical review and approval of manuscript. Sihvonen, Rantanen: study design, interpretation of results, critical review and approval of manuscript. Turunen: interpretation of results, critical review and approval of manuscript. Pesola: participant recruitment, interpretation of results, critical review and approval of manuscript. Arkela: participant recruitment, data collection, interpretation of results, critical review and approval of manuscript. Kallinen: study concept and design, clinical data collection, interpretation of results, critical review and approval of manuscript. Törmäkangas: data analysis, interpretation of results, writing the manuscript. Sponsor's Role: The funders had no involvement in the design, methods, subject recruitment, data collection, or preparation of the manuscript." @default.
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• W2498329431 date "2016-07-26" @default.
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• W2498329431 title "Recovery of Lower Extremity Performance After Hip Fracture Depends on Prefracture and Postdischarge Mobility: A Subgroup Analysis of a Randomized Rehabilitation Trial" @default.
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• W2498329431 doi "https://doi.org/10.1111/jgs.14275" @default.
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