Abstract
ImportancePatients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown.ObjectiveTo examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility.Design, Setting and PatientsA prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012.InterventionA daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings.Main outcomes and MeasuresThe primary outcome was the change in training load (kg) during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength.ResultsThe strength training was commenced at a mean of 2.4 (0.7) days after surgery. The training loads (kilograms lifted) increased from 1.6 (0.8) to 4.3 (1.7) kg over 4.3 (2.2) training sessions (P<.001). The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2) to 0.61 (0.3) Nm/kg (P<.001), while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001). Only 3 of 212 sessions were not performed because of severe hip fracture-related pain.Conclusion and RelevanceProgressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design.Trial RegistrationClinicalTrials.gov ID: NCT01616030
Highlights
Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering
Factors affecting the functional prognosis after hip fracture surgery are multiple [1], and patients are at risk of decreased physical function [2,3,4], new injurious falls and fractures [5,6], and increased need of supportive care [7]
The General Mixed Model showed no significant interaction between type of fracture and progression of training loads over time, (P = .121, partial eta squared = .12), while there was a substantial progression in training loads for both fracture types
Summary
Factors affecting the functional prognosis after hip fracture surgery are multiple [1], and patients are at risk of decreased physical function [2,3,4], new injurious falls and fractures [5,6], and increased need of supportive care [7]. Physical therapy including strength training should optimally be implemented in the acute ward immediately following surgery, where the deficits are greatest, to avoid further functional decline and to substantially enhance recovery after a hip fracture. Elective surgery and hip fractures are not the same, preliminary evidence suggests that strength training implemented immediately following total hip [24] and knee [25] arthroplasty is feasible and does not appear to exacerbate postoperative symptoms. If this is true for patients following a hip fracture is currently unknown
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