Home-based multicomponent rehabilitation program for older persons after hip fracture: A randomized trial

Objective: To determine whether a home-based systematic multicomponent reha bilitation strategy leads to improved outcomes relative to usual care. Design: A randomized controlled trial with 12 months of follow-up. Setting: General community; 27 home care agencies. Participants: Three hundred four nondemented persons at least 65 years of a ge who underwent surgical repair of a hip fracture at two hospitals in New Haven, CT, and returned home within 100 days. Intervention: Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments (physical therapy) and activities of d aily living (ADL) disabilities (functional therapy) versus usual care. Main Outcome Measures: A battery of self-report and performance-based measu res of physical and social function. Results: There was no significant difference in the proportion of participa nts in the two groups who recovered to prefracture levels in self-care ADL at 6 months (71% vs 75%) or 12 months (74% in both groups) or in home manag ement ADL at 6 months (35% vs 44%) or 12 months (44% vs 48%). There also wa s no difference between the two groups in social activity levels, two timed mobility tasks, balance, or lower extremity strength at either 6 or 12 mon ths. Compared with participants who received usual care, those in the multi component rehabilitation program showed slightly greater upper extremity st rength at 6 months (p = .04) and a marginally better gait performance (p = .08). Conclusions: The systematic multicomponent rehabilitation program was no mo re effective in promoting recovery than usual home-based rehabilitation. Co mpared with previous cohorts, however, participants randomized to usual car e in our study received more rehabilitative and home care services and expe rienced a higher rate of recovery. This finding is important given the curr ent pressures to reduce home services. The challenge is to determine the co mposition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fr acture. (C) 1999 by the American Congress of Rehabilitation Medicine and th e American Academy of Physical Medicine and Rehabilitation.