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· DOS Abstracts
Efficacy of acute in-hospital physiotherapy with
versus without knee-extension strength training
in reducing strength deficits in patients with a hip
fracture: a randomised controlled trial
Lise Kronborg, Thomas Bandholm, Henrik Palm, Henrik Kehlet, Morten Tange
Kristensen
Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department
of Physical Therapy, Copenhagen University Hospital at Hvidovre; Physical Medicine
and Rehabilitation Research – Copenhagen (PMR-C), Department of Physical Therapy,
Clinical Research Centre, Department of Orthopedic Surgery, Copenhagen University
Hospital at Hvidovre; Hip Fracture Unit, Department of Orthopedic Surgery, Copenhagen
University Hospital at Hvidovre; Section for Surgical Pathophysiology, Rigshospitalet,
Copenhagen University; Physical Medicine and Rehabilitation Research – Copenhagen
(PMR-C), Department of Physical Therapy, Department of Orthopedic Surgery,
Copenhagen University Hospital at Hvidovre
Background:
Patients with a hip fracture (HF) experience knee- extension strength def-
icit in the fractured limb of more than 50% and impaired physical function immediately
after HF surgery. This is likely to contribute to the long term loss of physical function,
change of residence and high mortality after HF.
Purpose / Aim of Study:
To determine whether daily acute in-hospital physiotherapy
(PT) with progressive knee-extension strength training (10RM) of the fractured limb
using ankle weight cuffs in 3 sets of 10 repetitions, is more efficacious in reducing knee-
extension strength deficit at follow-up compared to PT without strength training in pa-
tients with a HF.
Materials and Methods:
A randomized, assessor-blinded study of 90 patients (mean
age 79.6 (7.5) years, 69 women, 52 with a trochanteric fracture) admitted to the Hip
Fracture Unit at Hvidovre Hospital. The primary outcome was the change in maximal
isometric knee-extension strength in the fractured limb in % of the non- fractured limb
from 1-3 days after surgery (baseline) to postoperative day 10 or discharge (follow-up).
Findings / Results:
In the intention-to-treat analysis of between-group differences,
the primary outcome improved 8.1%, CI (-2.3; 18.4) by additional strength training from
baseline to follow-up versus a significant improvement by 10.5%, CI (0.3; 20.7) in the
per- protocol analysis of non-missing data.
Conclusions:
In-hospital PT with strength training was not more efficacious, although in
favor, compared to PT without strength training in reducing the knee- extension strength
deficit at follow-up in patients with HF, and the participants had a substantial strength
deficit at follow-up despite targeted PT. It is debatable whether larger improvements
than the observed can be expected given that only five exercise sessions, on average,
were completed. Trial identifier: NCT00848913
No conflicts of interest reported
121.