Abstract
BackgroundEarly mobilization after surgery is a key recommendation for people with hip fracture, however this is achieved by only 50% of people. Recumbent bike riding has been used in other populations with limited mobility and has potential to allow early exercise in people post hip fracture. The primary aim of this pilot trial was to demonstrate the feasibility of a trial protocol designed to determine the effect of early post-operative cycling in bed on outcomes in people with hip fracture.MethodsSingle-blinded, multi-site randomized controlled pilot trial. Fifty-one people with hip fracture were recruited within 4 days of surgery from two sites in Victoria. Participants were randomly allocated to receive either usual care (n = 25) or usual care plus active cycling in bed (n = 26). The cycling intervention was delivered on weekdays until the participant could walk 15 m with assistance of one person. The primary outcomes were trial feasibility and safety. Clinical outcomes, including mobility (Modified Iowa Level of Assistance Scale) and delirium were measured at day seven post-operatively and at hospital discharge by an assessor blinded to group. Additional outcomes at discharge included gait speed, cognition and quality of life.ResultsThe intervention was safe, feasible and acceptable to patients and staff. Delivery of the intervention was ceased on (median) day 9.5 (IQR 7, 12); 73% of scheduled sessions were delivered; (median) 4 sessions (IQR 2.0, 5.5) were delivered per participant with (median) 9 min 34 s (IQR 04:39, 17:34) of active cycling per session. The trial protocol was feasible, however at day seven 75% of participants had not met the criterion (able to walk 15 m with assistance of one person) to cease the cycling intervention..ConclusionIn bed cycling is feasible post-operatively following hip fracture, however seven days post-operatively is too early to evaluate the impact of the cycling intervention as many participants were still receiving the intervention. A fully powered RCT to explore the effectiveness and cost efficiency of this novel intervention is warranted.Trial registrationThe trial was prospectively registered (25/09/2017) with the Australian New Zealand Clinical Trials Registry ACTRN12617001345370.
Highlights
Mobilization after surgery is a key recommendation for people with hip fracture, this is achieved by only 50% of people
In bed cycling is feasible post-operatively following hip fracture, seven days post-operatively is too early to evaluate the impact of the cycling intervention as many participants were still receiving the intervention
Participant recruitment and retention Fifty-one participants were recruited between 14 November 2017 and 29 January 2019, with the final discharge assessment completed on 18 February 2019
Summary
Mobilization after surgery is a key recommendation for people with hip fracture, this is achieved by only 50% of people. Recumbent bike riding has been used in other populations with limited mobility and has potential to allow early exercise in people post hip fracture. Hip fracture is common and potentially life changing event. An estimated 296,000 people sustained hip fractures in the United States (US) in 2005 [1] and with the ageing population, it is anticipated numbers will increase. Regaining the ability to walk following hip fracture is critical to short and long term outcomes [4,5,6]. People with hip fracture are typically older with complex health issues which can delay walking post-operatively. Walking can be resource intensive during the early post-operative phase, often requiring two people
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