Original StudyEffects of High-Intensity Progressive Resistance Training and Targeted Multidisciplinary Treatment of Frailty on Mortality and Nursing Home Admissions after Hip Fracture: A Randomized Controlled Trial
Section snippets
Trial Design
This was a randomized, parallel-group superiority trial with an intention-to-treat analytic strategy, irrespective of dropout or discontinuation of intervention.31 There were no missing data for primary outcomes of mortality and nursing home admissions, and missing data for other primary outcomes were handled via imputation as recommended.32 We conducted blinded assessment of 2 disability outcomes: the Functional Independence Measure (FIM)33 and the Assessment of Living Skills and Resources
Flow of Participants
Participants were recruited between February 2003 and April 2007, closing when funding ceased. All but one hip fracture patient admitted during recruitment (773/774; 99.9%) were assessed for eligibility, and 47% (124) of the 262 potentially eligible hip fracture patients consented (Figure 1). Hip fracture patients who were ineligible (n = 512), eligible but refused (n = 138), and consented (n = 124) were similar in age (79, 80, and 79 years, respectively; P = .79) and gender (67%, 67%, and 69%
Interpretation
One year of high-intensity progressive resistance training combined with a targeted multifactorial intervention directed at major predictors of frailty reduced mortality and nursing home use over 12 months by more than 80% after hip fracture. Additionally, independence in toileting and transferring and assistive device usage were significantly improved by HIPFIT compared with usual care.
Notably, usual care included inpatient orthogeriatric and allied health consultation, followed by 6 to 12
Conclusions
We have shown for the first time that provision of 12 months of supervised high-intensity progressive resistance training, with simultaneous targeting and treatment of other deficits related to frailty in a typical hip fracture cohort is feasible and effective. The HIPFIT intervention resulted in statistically significant and clinically meaningful reductions in mortality, nursing home use, ADL dependency, and assistive device usage. Rehabilitation withdrawn when prefracture levels of mobility
Acknowledgments
We are grateful for the assistance of Associate Professor Cherry Russell for acquisition of funding and study design and intervention implementation, the Ophthalmology Department of Royal Prince Alfred Hospital for assessments and treatment provided, Ms Amanda Eames for participant recruitment and training, to Helen Badge and Louise Cowles for blinded outcome assessments, to Michael Baker for statistical assistance, to the staff of Royal Prince Alfred and Balmain Hospitals for assistance with
References (59)
- et al.
Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment
J Am Med Dir Assoc
(2011) - et al.
Treatment and prevention of depression after surgery for hip fracture in older people: Cost-effectiveness analysis
J Affect Disord
(2011) - et al.
Outpatient management of the elderly patient following fragility hip fracture
Am J Med
(2011) - et al.
Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur
Br J Anaesth
(2011) - et al.
The structure and stability of the Functional Independence Measure
Arch Phys Med Rehabil
(1994) - et al.
The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients
Nutrition
(1999) - et al.
The Physical Activity Scale for the Elderly (PASE): Development and evaluation
J Clin Epidemiol
(1993) - et al.
Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals
Psychosomatics
(1993) - et al.
Epidemiology and outcome of fracture of the hip in women aged 65 years and under: A cohort study
J Bone Joint Surg Br
(2011) - et al.
Increasing age- and sex-specific rates of hip fracture in Mexico: A survey of the Mexican institute of social security
Osteoporos Int
(2011)
Age, cohort and period effects on hip fracture incidence: Analysis and predictions from New Zealand data 1974–2007
Osteoporos Int
Trends in hip fracture rates in Ecuador and projections for the future
Rev Panam Salud Publica
Incidence and mortality of hip fractures in the United States
JAMA
Having had a hip fracture—association with dependency among the oldest old
Age Ageing
Quality of life related to fear of falling and hip fracture in older women: A time trade off study
BMJ
Prevention of falls in the community
BMJ
Training-induced strength and functional adaptations after hip fracture
Phys Ther
Circumstances of falls causing hip fractures in the elderly
Clin Orthop Relat Res
Management of hip fracture in adults: Summary of NICE guidance
BMJ
Interventions used by physical therapists in home care for people after hip fracture
Phys Ther
Interventions for improving mobility after hip fracture surgery in adults
Cochrane Database Syst Rev
Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures
Cochrane Database Syst Rev
Mortality and morbidity after hip fracture: Can evidence based clinical pathways make a difference?
J Rheumatol
Physical activity and hip fracture disability: A review
J Aging Res
Hip fracture management, before and beyond surgery and medication: A synthesis of the evidence
Arch Orthop Trauma Surg
Mortality and cause of death in hip fracture patients aged 65 or older—a population-based study
BMC Musculoskelet Disord
Evaluation and management of hip fracture risk in the aged
Am J Med Sci
Optimizing screening for osteoporosis in patients with fragility hip fracture
Clin Orthop Relat Res
Physical inactivity and pain in older men and women with hip fracture history
Gerontology
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2022, Archives of Physical Medicine and RehabilitationCitation Excerpt :Studies that reported the means and SDs of functional outcomes described in table 1 for both the control and intervention groups were included in this analysis. Standardized mean differences (SMDs) between groups and the SE in the estimate of the SMD were calculated.32-52 The regression coefficient and associated 95% CI were reported, along with I2 and adjusted R2 values to determine what degree the variables included in the model explained the variance in trial outcomes.
This work was carried out at the Exercise Health and Performance Research Group, Faculty of Health Sciences, University of Sydney.
This study was funded by the Australian National Health and Medical Research Council (NH&MRC), project grant 211226, administered by The University of Sydney. The funding organization and the University of Sydney had no role in the design and conduct of the study; nor in the collection, management, analysis, and interpretation of the data; nor in preparation, writing, review, decision to submit for publication or approval of the manuscript. There was complete independence of researchers from funders and sponsors; and all researchers had complete access to all the data.
Ethics approval was granted by the University of Sydney Human Research Ethics Committee and Sydney South West Area Health Service Ethics Review Committee in 2002. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTN12605000164695).