Home-based Physiotherapy Research Articles

A Mixed Methods Analysis of Patient Adherence to Home-Based Physical Therapy Exercises

Objective:The purpose of this study was to explore how a variety of personal and provider factors might be related to adherence to home-based exercises in a rehabilitation setting.Methods:This study used survey methodology and mixed methods analyses to examine adherence to home-based exercises among a sample (N= 117) of outpatient physical therapy patients.Findings:Hierarchical logistic regression determined previous adherence to home-based exercises, self-efficacy, motivation, and social support-explained significant variance (56%) in adherence to current home exercise prescription. Additional variables that had small but significant contributions were sex, education, and therapeutic alliance. Qualitative content analyses found participants frequently reported a lack of time as a barrier and indicated receiving both emotional and instrumental forms of social support; they also highlighted the importance of good communication with the therapist.Conclusions:A useful strategy to prepare patients for being adherent to home-based exercises is multistage goal setting, and rehabilitation educators and professionals might consider how to incorporate effective goal setting into curriculum and practice in order to prepare patients for potential barriers, develop self-efficacy, and identify social supports who can assist in goal commitment and achievement.

The Effectiveness of Virtual and Augmented Reality in Surgical Pain Management: A Systematic Review of Randomized Controlled Trials.

Satisfactory management of postoperative pain remains challenging. Nonpharmacological modalities such as virtual and augmented reality (VR/AR) offer potential benefits and are becoming increasingly popular. This systematic review evaluates the effectiveness and safety of VR/AR interventions on postoperative pain and recovery. MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL databases were searched from inception to July 27, 2023, for randomized controlled trials (RCTs), published in English, evaluating the use of VR/AR interventions for surgical pain relief. Study selection and data extraction were performed by pairs of reviewers independently and in duplicate, and potential risk of bias was determined using the Risk of Bias-version 2 (RoB 2) tool. Our outcomes included pain relief, reduction of anxiety, satisfaction, and adverse effects. Due to substantial heterogeneity, a narrative synthesis without meta-analysis was performed. We included 35 trials among 2257 citations, categorized as surgery (n = 12), minor procedures (n = 15), and postoperative physiotherapy (n = 8). Surgical group included various surgeries, with 11 using immersive VR predominantly in the postoperative period, and most reporting no differences in pain, but potential for reduced anxiety and sedation requirements. In the minor procedures group, most studies reported decreased pain and anxiety during the procedural performance. Two studies reported increased heart rate, while 2 others reported better hemodynamic stability. Home-based AR physiotherapy achieved (n = 6) similar pain and functional outcomes after knee replacement, with 1 large study (n = 306) reporting reduction of mean costs by $2745 for provision of 12 weeks physiotherapy. There were some concerns around potential bias for most studies, as the nature of interventions make it challenging to blind assessors and participants. No important adverse effects were noted using VR/AR technology. Evidence from RCTs indicates that the use of immersive VR during minor procedures may reduce procedural pain, decrease anxiety, and improve satisfaction. However, small studies, inconsistent effect, and variation in the application of interventions are important limitations. Evidence to support the application of AR/VR for major surgeries is limited and needs to be further investigated. Use of home-based physiotherapy with AR likely has economic advantages, and facilitates virtual care for appropriate patients who can access and use the technology safely.

The Role of Secondary Conservative Management Strategies in Bladder and Bowel Dysfunction: A Systematic Review and Meta-analysis

We sought to determine the effect of secondary management strategies in addition to urotherapy on bowel bladder dysfunction outcomes. The review protocol was prospectively registered (CRD42023422168). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (database initiation until June 2023) were searched. Comparative studies of secondary management strategies vs conventional urotherapy alone were included. Two authors independently screened titles, abstracts, and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. In this systematic review and meta-analysis of 18 studies and 1228 children, secondary management strategies (home-based education, biofeedback, and physical therapy) were associated with reduced symptom burden, fewer recurrent urinary tract infections, and improved uroflowmetry findings than children treated solely with urotherapy for conservative management. Although there is significant reporting heterogeneity, secondary conservative management strategies such as home education, biofeedback or cognitive behavioral therapy, and physiotherapy-based education are associated with less urinary incontinence, fewer infections, and fewer abnormal uroflowmetry findings.

E045 Adherence to physiotherapy among patients with knee osteoarthritis in a rheumatology specialized care unit in Sri Lanka

Abstract Background/Aims Knee osteoarthritis is a degenerative joint disorder that has a significant impact on global health and healthcare resources. Non-pharmacological interventions play a vital role in the management of osteoarthritis, and their effectiveness relies on the patient’s active participation and adherence. But non-adherence to these interventions including physiotherapy has become a recognized problem across the globe. The extent of adherence to physiotherapy specifically in the Sri Lankan population with osteoarthritis has not been assessed to date. Methods This cross-sectional study was conducted at Rheumatology and Rehabilitation Hospital, Ragama, Sri Lanka recruiting 100 patients diagnosed with knee joint osteoarthritis according to the EULAR 2011 Recommendations. General Rehabilitation Adherence Scale (GRAS) was used to score the adherence level to center-based physiotherapy. Home-based physiotherapy adherence was measured using a 5-point scale. Demographic data also were assessed to determine the associations with adherence levels. Data were analysed by using the Statistical Package of Social Sciences (SPSS). Results The study population consisted of 93% females and 7% males. Center-based physiotherapy adherence according to the GRAS score revealed 53% had a high adherence rate while 8% found poorly adhered to. Of the highly compliant patients, the majority, 35.8% patients were within the 60-69 years age group and 35.8% were housewives. 37.7% were not having co-morbidities. 41.7% have reported a disease duration of 1-5 years. The majority complained that they had poor adherence due to other commitments (36%) followed by and lack of time (34%). The third common cause for the default was transport expenses (26%). 91% of patients had knowledge of home-based physiotherapy activities. Of them, 32% followed the exercise regime as advised and 13% continued it as far as possible. 17% were unable to engage in those at all. As reasons for noncompliance to home therapy, 35% of patients reported having a lack of time and 31% had poor motivation. None of the sociodemographic factors significantly correlated with center-based or home-based physiotherapy adherence. Conclusion The findings indicate that a significant proportion of patients demonstrated high adherence to center-based physiotherapy. Although a majority of patients had knowledge of home-based physiotherapy activities, only a portion followed the prescribed exercise regime. Addressing barriers such as time constraints, commitments, and transportation expenses is crucial. Future research should explore personalized approaches and innovative strategies to enhance engagement and overcome challenges to optimize physiotherapy adherence. Disclosure S.K. Ubhayasiri: None. D. Abeysinghe: None.

A Comparison of the short-term effects of steroid injection, prolotherapy and home-based physiotherapy in patients with chronic lateral elbow tendinopathy

Aim: This study aims to compare the effects of steroid injection (SI), prolotherapy, and home-based physiotherapy on pain and function in short-term in chronic lateral elbow tendinopathy (LET) patients. Materials and Methods: Patients with chronic LET admitted to the orthopedic clinic between 2022 and 2023 were divided into SI (n=17), prolotherapy (n=17) and home-based physiotherapy (n=17) groups. Visual Analogue Scale (VAS), Quick Disability Assessment of Arm, Shoulder and Hand Problems (QuickDASH), and Health Assessment Questionnaire (HAQ) for pain and function before, two, and six weeks after treatment were compared. Results: Second and sixth-week VAS, QuickDASH and HAQ were significantly lower in SI and prolotherapy than home-based physiotherapy group (p=0.001). In the sixth week, sufficient improvement was achieved in VAS, QuickDASH and HAQ in SI compared to prolotherapy and home-based physiotherapy (p=0.001, η2=0.30-0.42). Conclusion: SI, prolotherapy, and home-based physiotherapy improved elbow pain and function in short-term, but SI was greater effective. SI may be effective for short-term improvement in chronic LET patients.

88 Feasibility of a Home-based Physiotherapy Program to Increase Physical Activity Levels in Older Adults with Diabetes Mellitus

OBJECTIVES/GOALS: The objective of this study is to assess the feasibility and preliminary impact of a physiotherapy protocol for developing an individualized home-based physical activity program to increase physical activity (PA) levels in sedentary older adults with Type II Diabetes Mellitus (T2DM) living in Puerto Rico (PR). METHODS/STUDY POPULATION: This will be a pilot study with two phases. In phase 1, we will design a novel patient-centered home-based PA program protocol for adults ≥65 years with T2DM based on the Information-Motivation-Behavioral Skills model. Its content validity will be assessed through focus groups with 10 experts and 10 older adults and analyzed using a directed content analysis. Phase 2 we will be program implementation using a one-group, repeated measures design with 12 adults ≥65 years with T2DM. PA levels will be assessed by recording active minutes with a Fitbit. Risk of falls, balance, strength, and physical function will be assessed through standardized tests validated for this population. Statistical analysis will include descriptive statistics, comparisons via chi-square/Fisher’s exact test, and non-parametric tests. RESULTS/ANTICIPATED RESULTS: We expect to recruit a minimum of 12 participants and to administer the program for 12 weeks at a frequency of two visits per week. We anticipate that implementing and supervising the home-based PA protocol will be feasible as determined by recruitment and retention rates, patients’ satisfaction, and compliance with the program. We also expect that this protocol will increase physical activity levels, improve general strength, balance, physical function, and reduce the risk of falls in sedentary older adults with T2DM. DISCUSSION/SIGNIFICANCE: As the third cause of death in PR, T2DM represents a public health challenge. An effective home-based PA program may decrease morbidity and mortality rates in older adults by increasing PA and functional health. This study will provide data for planning a randomized controlled trial to assess its effectiveness in the outcomes of interest.

Effects of Multicomponent Home-Based Intervention on Muscle Composition, Fitness, and Bone Density After Hip Fracture.

Mechanistic factors on the pathway to improving independent ambulatory ability among hip fracture patients by a multicomponent home-based physical therapy intervention that emphasized aerobic, strength, balance, and functional training are unknown. The aim of this study was to determine the effects of 2 different home-based physical therapy programs on muscle area and attenuation (reflects muscle density) of the lower extremities, bone mineral density (BMD), and aerobic capacity. Randomized controlled trial of home-based 16 weeks of strength, endurance, balance, and function exercises (PUSH, n = 19) compared to seated active range-of-motion exercises and transcutaneous electrical neurostimulation (PULSE, n = 18) in community-dwelling adults >60 years of age within 26 weeks of hip fracture. In PUSH and PULSE groups combined, the fractured leg had lower muscle area and muscle attenuation and higher subcutaneous fat than the nonfractured leg (p < .001) at baseline. At 16 weeks, mean muscle area of the fractured leg was higher in the PUSH than PULSE group (p = .04). Changes in muscle area were not significantly different when compared to the comparative PULSE group. There was a clinically relevant difference in change in femoral neck BMD between groups (p = .05) that showed an increase after PULSE and decrease after PUSH. There were generally no between-group differences in mean VO2peak tests at 16-week follow-up, except the PUSH group reached a higher max incline (p = .04). The treatment effects of a multicomponent home-based physical therapy intervention on muscle composition, BMD, and aerobic capacity were not significantly different than an active control intervention in older adults recovering from hip fracture. ClinicalTrials.gov Identifier: NCT01783704.

Using Multiphase Optimization Strategy and Human-Centered Design to Create an Integrated Model of Palliative Care Skills in Home-Based Physical Therapy for Advanced Heart Failure.

Background: Many older adults with advanced heart failure receive home health rehabilitation after hospitalization. Yet, integration of palliative care skills into rehabilitation is limited. Objective: Describe using the Multiphase Optimization Strategy (MOST) framework with human-centered design principles to engage clinical partners in the Preparation phase of palliative physical therapy intervention development. Design: We convened a home-based physical therapy advisory team (four clinicians, three clinical leaders) to identify physical therapist needs and preferences for incorporating palliative care skills in rehabilitation and design an intervention prototype. Results: Between 2022 and 2023, we held five advisory team meetings. Initial feedback on palliative care skill preferences and training needs directly informed refinement of our conceptual model and skills in the intervention prototype. Later feedback focused on reviewing and revising intervention content, delivery strategy, and training considerations. Conclusion: Incorporating human-centered design principles within the MOST provided a useful framework to partner with clinical colleagues in intervention design.

Commentary: Physical therapy for sleep apnea: a smartphone application for home-based physical therapy for patients with obstructive sleep apnea.

Commentary: Physical therapy for sleep apnea: a smartphone application for home-based physical therapy for patients with obstructive sleep apnea.

The Content of Physiotherapy and Factors Impacting on Reablement - A National Study.

Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.

Multicomponent Home-based Physical Therapy Versus Usual Care for Recovery After Hip Fracture

ObjectiveTo quantify the effect of 2 home-based 16-week multi-component physical therapy interventions on functional recovery compared to usual care after hip fracture. DesignCross-study comparison using participants from the Community Ambulation Project (CAP; a randomized controlled trial) were compared to the Baltimore Hip Studies-seventh cohort (BHS-7; an observational cohort study) at 3 different time points (CAP: 15, 31, 55 weeks; BHS-7: 8, 26, and 52 weeks). SettingGeneral community ParticipantsCombined convenience sample of hip-fracture patients 8-26 weeks post admission from a prospective cohort study and randomized controlled trial. (N=549) InterventionsCAP participants were randomized to one of 2 interventions (PUSH: specific multi-component intervention; PULSE: non-specific multi-component intervention) after standard rehabilitation; BHS-7 participants received usual care. Main Outcome MeasuresMean function (as measured by Short Physical Performance Battery (SPPB) and gait speed) was estimated in each cohort as quadratic functions of time using data from 3 post-fracture assessments in both studies (CAP: 15, 31, 55 weeks; BHS-7: 8, 26, and 52 weeks). ResultsThe harmonized samples included 101 PUSH, 100 PULSE, and 128 BHS-7 participants that had different demographic and clinical characteristics. Mean baseline SPPB scores (meters per second) were PUSH: 5.5 (SD=2.2), PULSE: 5.5 (SD=2.4), and BHS-7: 4.6 (SD=2.5); and mean gait speeds were 0.60 m/s (SD=0.20) for PUSH, 0.59 m/s (SD=0.17) for PULSE, and 0.46 m/s SD=(0.21) for BHS-7, respectively. Estimated between-group differences for SPPB improvement from 75 days to 1-year post admission were 0.7 (P=.04) in PUSH vs BHS-7; and 0.9 (P=.01) in PULSE vs BHS-7. Mean differences in change in gait speed were 0.08 (P=.002) for PUSH vs BHS-7; and 0.06 (P=.02) PULSE vs BHS-7 (P=.02). ConclusionsFindings from this cross-study comparison that combined participants from 2 separate studies, with different designs and samples, suggest that home-based multi-component physical therapy programs were associated with greater functional improvement after hip fracture compared to usual care.

Challenges in rehabilitation and continuum of care provision after knee replacement: a mixed-methods study from a low- and middle-income country

Purpose Continuum-of-care is crucial following knee replacement. This is an understudied area in the context of low- and middle-income countries. We report findings of a mixed-methods study conducted to understand patient’s postoperative experiences in following unsupervised home-based physiotherapy protocols and healthcare provider’s experiences in providing rehabilitation care. Methods Consecutive adults (n = 79) scheduled or had undergone knee replacement, attending an urban tertiary care hospital in India completed a 22-item questionnaire to gauge attitude towards physical rehabilitation. We conducted in-depth interviews with nine patients, ten physiotherapists, and three surgeons using a phenomenology approach. Data were interpreted using the capability, opportunity, and motivation-behaviour (COM-B) framework. Results Patients were motivated to do exercises and valued family support during the recovery period. However, they desired physiotherapy support, especially during the early recovery period due to post-operative pain. Healthcare providers reported poor adherence with the exercise regimen and desired a mechanism to monitor patient progress after discharge. Patients and health care providers identified accessibility to rehabilitation centre as a major barrier in availing affordable and reliable physiotherapy services. Conclusion There is a need for a continuum of care to improve patient experience during recovery and for health care providers to monitor progress and provide personalised progressive exercise therapy.

Poster 159: At-home physical therapy with a remote monitoring digital health platform leads to similar patient reported outcomes compared to traditional in-office physical therapy following shoulder surgery

Objectives: Physical therapy (PT) following shoulder surgery has traditionally occurred via in-office supervised visits. Recently digital health tools with remote patient monitoring (RPM) have emerged as an option to enhance the ability to both monitor and encourage engagement of home PT. The appeal of such tools has been accelerated by the impact of COVID-19 on the healthcare system. The primary purpose of this study was to compare patient-reported outcomes (PROs) following shoulder surgery of patients who completed at-home PT with a digital rehab application to patients who completed in-office supervised PT. The secondary purpose was to assess engagement among patients who used digital PT. Methods: A retrospective matched comparative evaluation was performed of patients who underwent arthroscopic shoulder surgery or shoulder arthroplasty at a single institution between April 2020 and May 2021. Patients who underwent home-based physical therapy with a digital remote monitoring platform (PT Genie; Orland, FL) were identified and age and procedure matched (arthroscopy or arthroplasty) to a cohort of patients that underwent in-office physical therapy. The digital platform provided remote monitoring capabilities with measurement of range of motion. PROs measured preoperatively and at 1 year postoperative included visual analog scale pain score (VAS), American Shoulder Elbow Surgeons Score (ASES), and Single Assessment Numeric Evaluation (SANE). Engagement measured as the number of sessions recorded was analyzed in the digital PT based on 6 age groups (≤40, 41-50, 51-60, 61-70, 71-80, and 81+). Statistical analysis using the student t-test to compare means was performed using SPSS version 17 (SPSS Inc., Chicago). Results: A total of 862 patients were identified, including 396 arthroscopic surgeries (198 in each PT group) and 466 in the arthroplasty group (233 patients in each PT group). The groups were similar at baseline other than a higher preoperative ASES score in the digital PT arthroplasty group (Table 1). There was no significant difference in any PROs between the two groups at 1-year follow-up. The highest engagement in the digital PT group was observed in the arthroplasty group and over the age of 50 (Figure 1). Conclusions: There appears to be no difference in PROs following shoulder surgery whether physical therapy is performed in-office or at home via a digital platform. Interestingly, engagement with digital PT was highest in older patients, suggesting that the technology is not a large barrier. Although further study is needed to confirm these findings, benefits of digital PT with remote monitoring may include: 1) Decreased cost for the healthcare system, 2) Decreased travel time for the patient, and 3) Scheduling efficiency and improved access to the PT for the patient.

Physical therapy for sleep apnea: a smartphone application for home-based physical therapy for patients with obstructive sleep apnea.

In this study, we described "PT for Sleep Apnea", a smartphone application for home-based physical therapy of patients with Obstructive Sleep Apnea (OSA). The application was created in a joint program between the University of Medicine and Pharmacy at Ho Chi Minh City (UMP), Vietnam, and National Cheng Kung University (NCKU), Taiwan. Exercises maneuvers were derived from the exercise program previously published by the partner group at National Cheng Kung University. They included exercises for upper airway and respiratory muscle training and general endurance training. The application provides video and in-text tutorials for users to follow at home and a schedule function to assist the user in organizing the training program, which may improve the efficacy of home-based physical therapy in patients with Obstructive Sleep Apnea. In the future, our group plans to conduct a user study and randomized-controlled trials to investigate whether our application can benefit patients with OSA.

Home-Based Physiotherapy and Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis: A Review.

The objective of the study is to review the studies on home-based pulmonary rehabilitation practices in idiopathic pulmonary fibrosis patients in the last 5 years. Home-based randomized controlled trials in idiopathic pulmonary fibrosis patients published in the PubMed database within the previous 5 years were searched. As a result of the research, a total of 5 articles were included in the study. Five home-based rehabilitation practices used in these articles were reached. Totally, 176 patients were found to have participated in these programs. As a result, patients who have difficulty accessing hospital-based rehabilitation services due to various reasons will benefit from home-based rehabilitation services. However, the content of the home-based program and the method of follow-up and supervision affect the results.

The effectiveness of home-based physical therapy on glycemic control and quality of life in adults with prediabetes

Background: Prediabetes is the preceding stage of diabetes which puts an individual to induce complications same as that of diabetes; hence, it should be treated to prevent its progression to diabetes and other consequences. However, there is very less literature about impact of home-based physical therapy on glycemic control and quality of life in Indian prediabetic population. Aims and Objectives: The aims of this study were to evaluate whether the home-based physical therapy shows effect on glycemic control and individual’s quality of life after a 3-month intervention. Materials and Methods: The study was conducted on 55 individuals who were diagnosed with prediabetes (36 males and 19 females) on basis of HbA1c level ranging from 5.7% to 6.4%. A 12-week exercise protocol was made which includes warm up exercises, main exercise program (aerobic and strengthening training), and cool down exercises along with dietary changes. SF-36 and HbA1c level is taken at baseline and at the end of 12 weeks for quality of life and glycemic control measures in participants, respectively. Results: The difference in HbA1c levels before and after treatment was found to be statistically significant. The HbA1c levels after the 3-month intervention showed significant reduction (P &lt; 0.008) along with significant difference in all domain of SF-36 except in domain 3 (role limitation due to emotional problem) and domain 6 (social functioning). Conclusion: The home-based physical therapy program is effective in glycemic control and quality of life in adults with prediabetes.

Musculoskeletal Pain Disorder Patients’ Adherence to Physiotherapy Treatment: A Cross Sectional Study

Background &amp; purpose: Musculoskeletal disorders (MSDs) are diseases or pain in the musculoskeletal systemof the human body, which consists of the joints, ligaments, muscles, nerves, tendons, and structures that supportthe limbs, neck, and back. MSDs can be the result of a quick exertion (e.g., lifting a large object), repetitive strain,or constant exposure to force, vibration, or awkward posture. The study aimed to determine musculoskeletalpain disorder patients’ adherence to home-based physiotherapy programs in the outpatient musculoskeletaldepartment.Methods: The cross-sectional study was chosen to carry out this study among 200 participants who were selectedaccording to inclusion criteria. The Adherence in Chronic Diseases Scale (ACDS) was used to assess the adherencelevel to physiotherapy treatment. The study was conducted by using quantitative descriptive analysis.Results: Most of the participants were medium adherent to physiotherapy treatment. Although this study founda significant association between different socio-demographic factors with adherence to physiotherapy treatmentsuch as age, marital status, treatment sessions, and timely arrival for physiotherapy treatment.Conclusion: This study concluded that most patients who are receiving treatment have moderate adherence toprescribed physiotherapy treatment at home.

A walking programme for adults living in the community after hip fracture: A feasibility randomized controlled trial

Objective To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. Design A randomized controlled trial with embedded qualitative analysis. Setting Community. Participants Aged at least 60 years and living in the community after hip fracture. Interventions In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking. Main outcome measures Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy. Results Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2–13). There were no between-group differences in mobility, walking confidence or quality of life. Conclusion A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.

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

ObjectiveTo investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. DesignA single-blinded randomized controlled trial. SettingGeneral community. ParticipantsThirty-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). InterventionPUSH 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 MeasuresGait 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. ResultsAt 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. ConclusionGait 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.

Home-based Exercise Versus Supervised Physical Therapy On Shoulder Pain And Function: A Meta-analysis

Supervised physical therapy is generally the first choice as a conservative treatment of shoulder pain, but its cost is relatively high and is increasing in recent years. Home-based exercise could be a less costly and less-time consuming alternative as compare to supervised physical therapy. Research evidence on the effectiveness of home-based exercise versus supervised physical therapy on shoulder rehabilitation is limited. PURPOSE: To compare the treatment efficacy of home-based exercise alone versus supervised physical therapy for adults with shoulder disorders. METHODS: A meta-analysis followed PRISMA guidelines was conducted. Five electronic databases (EMBASE, MEDLINE, CENTRAL, CINAHL and PEDro) were searched to identify eligible randomized clinical trials in February 2021. Outcomes of interest included pain intensity and functional disability. The meta-analysis was performed in RevMan V.5.4 software. The pooled effect size was calculated based on a fixed-effects model using standardized mean difference (SMD) and corresponding 95% confidence intervals (CI). The PEDro scale was used to assess the quality of included studies, and the GRADE approach was used to assess the overall quality of the evidence. RESULTS: Eight studies with 711 participants were included. Overall, no significant differences were found between home-based exercise and supervised physical therapy in pain reduction (SMD = 0.10; 95% CI: -0.05 to 0.24; I2 = 0%; p = 0.20) and function improvement (SMD = 0.02; 95% CI: -0.23 to 0.27; I2 = 0%; p = 0.87) in the short term. CONCLUSIONS: Moderate- to high-quality evidence showed that home-based exercise and supervised physical therapy has similar effects in reducing pain and improving function in the short term. Future studies should evaluate the mid- and long-term treatment efficacy of home-based exercise.