RESEARCH REPORT PLATFORM PRESENTATION

A PERI-OPERATIVE PHYSICAL THERAPY PROGRAM INCLUDING STRENGTH TRAINING AND ELECTRICAL STIMULATION MAY HELP COUNTERACT FUNCTIONAL DECLINE AFTER HIP FRACTURE. Beyer N¹, Albertsen B², Bährentz G², Rasmussen M², Suetta C³; ¹Institute of Sports Medicine – Copenhagen & Dept. Physical Therapy, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark. ²Dept. Physical Therapy, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark. ³Institute of Sports Medicine – Copenhagen, Copenhagen University Hospital Bispebjerg, Denmark

PURPOSE: It has been shown that functional muscle performance increased as a result of postoperative resistance training and electrical stimulation following hip replacement. Moreover, resistance training markedly reduced length of stay in these patients. The question is whether peri-operative physical therapy combined with resistance training and neuromuscular electrical stimulation can help counteract functional decline in hip fracture patients. RELEVANCE: Optimising physical therapy programs to counteract functional decline in hip fracture patients may potentially improve functional ability in a group of patients where many never recover their pre-fracture physical function. PARTICIPANTS: 103 patients, aged 60 years and older, admitted to the Department of Orthopaedics with a primary hip fracture between October 2004 and June 2006. Pre fracture all patients were home-dwelling and had independent walking function. METHODS: Patients who fulfilled the inclusion criteria were invited to participate in the randomised controlled (non-blinded) study. On inclusion the patients were randomly allocated to a standard physical therapy program (SR) consisting mainly of functional training as part of an accelerated hospital stay or standard physical therapy combined with resistance training (3/wk) and neuromuscular electrical stimulation (daily) of the operated side (RTES). The rehabilitation programmes were commenced the day after surgery. All patients were tested with the New Mobility Score (NMS, scores 0-9) to assess pre fracture functional mobility and Mini Mental State Examination (MMSE) to assess cognitive function. Three and 10 days post surgery the patients performed a 10-m walking test (habitual walking speed). ANALYSIS: Data are presented as median(range). Comparisons between the groups were calculated with the Mann-Whitney U test. RESULTS: Mean age was 81.5 yr (60-95)(RTES) and 82 yr (60-99)(SR). The majority of the participants had a relatively high functional mobility level pre fracture, NMS=9(2-9)(RTES) and NMS=9(2-9)(SR). MMSE was performed in 45 patients from both groups and very few were cognitively impaired, scores were 27(13-30)(RTES) and 28(20-30)(SR). 35 patients from RTES and 25 from SR were able to perform the 10-m walking test three days post surgery (29.53s (15.25-119.53), and 42.17s (16.75-115.00), p = 0.112). Data on 10-m walking test at three and 10 days post surgery existed in 26 patients from RTES and 19 from SR. Walking time improved in both groups, however the improvements were significantly greater in RTES compared with SR (from 27.44s (15.25-107.56) to 18.47s (11.00-37.00) vs. from 39.18s (16.75- 102.82) to 23.06s (15.00-123.00), p = 0.008). CONCLUSIONS: More participants in RTES-group were able to walk 10m three days post surgery and in those who performed the 10-m walking test three and 10 days post surgery the participants from RTES had a higher habitual walking speed than those from SR. Results from this study suggest that resistance training and neuromuscular electrical stimulation of the operated side may counteract some of the functional decline seen in hip fracture patients post surgery. The non-blindedness is the primary limitation of this study. IMPLICATIONS: An accelerated hospital stay improves recovery after hip fracture. Implementation of neuromuscular electrical stimulation and resistance training as part of the peri-operative physical therapy program may further improve functional ability in these patients. KEYWORDS: Resistance, NMES, fracture. FUNDING ACKNOWLEDGEMENTS: The study was partly funded by The Danish Rheumatism Association. CONTACT: nb01@bbh.hosp.dk

ETHICS COMMITTEE: The regional research ethics committees of Copenhagen and Frederiksberg