Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial.

Autor:	Huang MZ; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD., Rogers MW; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD., Pizac D; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD., Gruber-Baldini AL; Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD., Orwig D; Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD., Hochberg MC; Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD., Beamer BA; Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD; Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD., Creath RA; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Exercise Science, Lebanon Valley College, Annville, PA., Savin DN; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD., Conroy VM; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD., Mangione KK; Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA., Craik R; Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA., Zhang LQ; Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD; Department of Bioengineering, University of Maryland, College Park, MD., Magaziner J; Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD. Electronic address: jmagazin@som.umaryland.edu.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2023 Feb; Vol. 104 (2), pp. 169-178. Date of Electronic Publication: 2022 Sep 07.
DOI:	10.1016/j.apmr.2022.08.974
Abstrakt:	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 32-40 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<.05) and fast (P<.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%-7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.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. (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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