Enhancing Rehabilitation After Hip Fracture
- Conditions
- Hip Fracture
- Interventions
- Behavioral: Unilaterally Biased Resistance Training / "MOVE"
- Registration Number
- NCT02635308
- Lead Sponsor
- University of Utah
- Brief Summary
This study evaluates the feasibility of implementing a unilaterally biased high-intensity resistance training to facilitate restorative vs. compensatory recovery after "usual care" physical therapy among older adults who have recently incurred a hip fracture. Additionally, physical performance during a sit-to-stand task, muscle function (strength/power), physical function measures, muscle composition, and muscle quality (force/unit area), are assessed before and after targeted high-intensity resistance training.
- Detailed Description
Hip fracture is a major public health concern in the United States. Fall-related injuries constitute the leading cause of deaths and disabilities among persons over age 65 years. Hip fracture is consistently identified as one of the most frequent, costly, and devastating non-lethal injuries from a fall. Rehabilitation after hip fracture remains largely unchanged over the last 30 years despite evidence that high-intensity rehabilitation can benefit physical function after hip fracture beyond the recovery typical with "usual care".
Asymmetries demonstrated in physical performance of various tasks, such as gait, balance, and a sit-to-stand transfer, and impaired surgical limb muscle function are evident for years after hip fracture, and may contribute to the high rate of falls and declining function typically encountered by older adults recovering from hip fracture. Implementing a high-intensity rehabilitation approach targeting asymmetries after hip fracture is likely to yield improved symmetry in both physical function and muscle function. This study will recruit older adults who have recently incurred a hip fracture and completed "usual care" physical therapy to determine whether a high-intensity rehabilitation strategy targeting asymmetries in movement strategies and muscle function of the surgical limb can be successfully implemented in this challenging population. In particular, recruitment, adherence to rehab protocol parameters, and retention will be addressed among those who initiate high-resistance training at approximately 8-12wk after hip fracture incidence.
In addition, the investigators will explore the potential of targeted unilaterally-biased resistance training to improve surgical limb function and performance after hip fracture. Specifically, physical performance, muscle function, and muscle quality/composition are recorded and compared pre-/post-training to determine whether improvements occur in conjunction with high-intensity rehabilitation training. Additionally, the investigators will measure improvements in muscle composition that occur as a result of this high-intensity resistance training.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 24
- Age greater than 50 yrs
- Ability to sign informed consent
- Mental Status MoCA score greater than 22
- Independent community ambulatory prior to hip fracture
- Ability to ambulate greater than 50 feet with or without assistive device
- Previous hip fracture
- Bilateral hip fracture
- Pathological fracture
- Expected life Expectancy less than one year
- Permanently institutionalized
- Fracture result of multi-trauma
- Cardiac abnormalities
- Neuromuscular impairments
- Unstable medical conditions
- Elevated systolic greater than 150 or diastolic blood pressure greater than 100
- Implanted electronic devices
- History of stroke with motor disability
- Alcohol or drug abuse
- Respiratory disease
- Conditions deemed exclusionary by PI or physician
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Experimental Unilaterally Biased Resistance Training / "MOVE" High-Intensity, Unilaterally-Biased Resistance training 3x/wk x 12wk "MOVE"
- Primary Outcome Measures
Name Time Method muscle strength 12 week Knee extension muscle strength was measured on an isokinetic dynamometer as a maximum voluntary isometric contraction in newtons (N) of force. The average of three trials was used.
muscle power 12 week Leg extension muscle power was measured on a Nottingham power rig in watts (W). The average of three trials was used.
- Secondary Outcome Measures
Name Time Method Timed up and Go Test 12 week The Timed up and go test is recorded as the time in seconds to stand, walk 3 meters, turn around and return to a chair. The average time of three trials is reported.
Lower Extremity Measure 12 week The Lower Extremity Measure (LEM) is a 29-item self-report questionnaire that is reliable, valid, and responsive to improvement, with scores of 75 indicating moderate frailty, and scores above 85 indicating normal mobility and physical function after hip fracture. Scores range from 0-100.
muscle mass 12 week MRI analysis of quadriceps muscle mass reported as average cross-sectional area in cm2.
Berg Balance Scale 12 week The Berg Balance Scale (BBS) is a 14-item objective scale that provides a reliable and valid measure of static balance, with scores less than 45 indicating significant fall risk among older adults. Scores range from 0-56.
Stair Climb Test 12 week The time taken to ascend 10 stairs is reported.
sit-to-stand task performance 12 week biomechanics (vGRF) measured during sit-to-stand task performance
usual gait speed 12 week Gait speed was measured at usual speed over a 50 foot distance and reported in meters/second.
Activities Specific Balance Scale 12 week Activities-Specific Balance Confidence (ABC) scale is a 16-item, validated, reliable, self-report scale used to determine balance confidence. Scores range from 0-100.
Six minute walk test 12 week. The distance in meters (m) walked in six minutes is recorded.
Modified Physical Performance Test 12 week The modified physical performance test (mPPT) is a standardized nine-item test designed to assess multiple dimensions of physical function was used to assess overall physical function. Scores are reported on a scale from 0-36.
Stair Descent Test 12 week The time taken to descend 10 stairs is reported.