Sherrington C1, Lamb S2, Craik R3, Keene D4, Perracini M5
1University of Sydney, George Institute for Global Health, Sydney, Australia, 2University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford, United Kingdom, 3Arcadia University, College of Health Sciences, Glenside, United States, 4University of Oxford, Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, 5Universidade Cidade de Sao Paulo, Physical Therapy, Sao Paulo, Brazil
- To be informed about the latest findings from clinical trials in the rehabilitation and prevention of fragility fractures in older adults.
- To learn about clinical trial methodology as it relates to fragility fracture prevention and rehabilitation.
- To facilitate international collaboration in large trials of physiotherapy interventions.
Fragility fractures are a major and increasing global public health issue. By 2050 there are expected to be 4.5 million global hip fractures each year (1). Rehabilitation outcomes after fragility fracture are generally poor yet there are few large trials to guide physiotherapy practice in fracture rehabilitation (2) and no trials of fracture prevention using non-pharmacological interventions (3).
Large trials in four different countries are underway, representing a major advance in this neglected area. Each of these trials is the first or largest of its type, funded by a national competitive funding agency, led by a physiotherapist and involves a multidisciplinary investigator team.
The RESTORE trial in Australia (n=340) is the largest trial to date of a home exercise program taught by a physiotherapist and uses a motivational interviewing approach to maximise intervention uptake. It tests the impact of the program on mobility and falls. The Pre_FIT trial in the UK (n=9821) is the first trial to be powered to detect an impact of a fall prevention program on fractures. It tests the comparative effectiveness of advice, exercise and a multi-factorial fall prevention programme on peripheral fractures among older people living in the community The CAP trial in the USA (n=210) is the first trial of home-based strength training in hip fracture survivors. It tests the impact of the program on restoring community ambulation. The AIM trial in the UK (n=620) is the first trial to compare surgical and conservative management after ankle fracture for older people. The REATIVE trial in Brazil (n=80) is the first trial of home-based hip fracture rehabilitation to be conducted in a middle-income country. It tests the impact of the program on mobility-related disability.
Implications / Conclusions
The results of these trials will provide long-awaited direct evidence to guide physiotherapy practice internationally. Their successful conduct demonstrates the ability of physiotherapists to lead large-scale nationally-funded trials. Speakers will present results of these trials as well as leanings from their conduct. The symposium will facilitate future international research collaborations.
- Fragility fracture
National Health and Medical Research Council (Australia); National Institute of Health Research (UK); National Institutes of Health (USA); The São Paulo Research Foundation (Brazil).
Relevance to physical therapy globally
Fragility fractures are a major global public health issue. Rehabilitation outcomes are generally poor yet there are few large trials to guide physiotherapy practice in fracture rehabilitation and no trials of prevention. Internationally several large trials are being led by physiotherapists, representing a major advance in this neglected area.
Physiotherapy researchers, managers and clinicians interested in informing themselves about the latest evidence to guide practice.
Programme subject to change