SYSTEMATIC HOME-BASED PHYSICAL AND FUNCTIONAL THERAPY FOR OLDER PERSONS AFTER HIP FRACTURE

Objective: To describe the development, implementation, and results of a home-based rehabilitation protocol for older persons after hip frac ture. Design: Demonstration study. Setting: Community. Participants: O ne hundred forty-eight community-living, nondemented participants at l east 65 years of age who underwent repair of a fractured hip at two lo cal hospitals. Intervention: A linked assessment-intervention, home-ba sed rehabilitation strategy. The physical therapy (PT) component of th e intervention was designed to identify and ameliorate impairments in balance, strength, transfers, gait, and stair climbing; the functional therapy (FT) component was designed to identify and improve unsafe an d/or inefficient performance of specific activities of daily living (A DL). Main Outcome Measures: The percentage of participants able to com plete each component and the extent of progress noted in strength, bal ance, transfers, gait, and daily functioning. Results: A total of 104 of the 148 participants (70%) completed the 6-month PT and FT program; 4 completed only PT and 6 refused both PT and FT. The remaining 32 pa rticipants (22%) received partial PT and FT that was terminated by dea th, hospitalization, or institutionalization. Seventy-seven percent of participants reported performing at least half of the recommended dai ly exercise sessions. Ninety-four percent and 96% of participants prog ressed in upper and lower extremity conditioning respectively; 33% pro gressed to the highest level in the graduated resisted exercise progra m. All participants progressed in the competency-based graded balance program, with 55% progressing to the fifth (most difficult) level. Sim ilarly, the majority progressed in transfer maneuvers, stair climbing, and outdoor gait. One repetition maximum (RM) elbow extension increas ed from a mean of 5.8 (SD 4.6) pounds at baseline to 7.2 (SD 3.8) poun ds at 6mo (t 2.22; p < .02). One RM knee extension increased from 5.8 (SD 5.8) pounds to 10.8 (SD 5.4) pounds (t = 8.06; p < .0001). The num ber of gait deviations decreased from 2.1 (SD 1.3) to 0.6 (SD 0.9) (p < .0001), while the mean modified Berg Balance Scale Score increased f rom 13.0 (SD 4.8) to 20.5 (SD 6.8) (t = 16.6; p < .0001). Finally, the Total ADL Score increased from a mean of 48.2 (SD 15.0) to 77.7 (SD 1 8.8) (t = 17.03; p = .0001). Conclusions: This systematic assessment a nd intervention protocol, targeting impairments and ADL, was feasible, safe, and effective. Protocols such as the one presented should enhan ce the ability to implement rehabilitation programs for the increasing number of multiply impaired older persons receiving home-based therap y and to document the process and outcomes of this can. (C) 1997 by th e American Congress of Rehabilitation Medicine and the American Academ y of Physical Medicine and Rehabilitation.