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Objectives To investigate the effect of a yearlong multicomponent rehabilitation program on the level of physical activity (PA) and the maintenance of the level of PA over 1-year follow-up among older people recovering from a recent hip fracture. Design Secondary analysis of a randomized, controlled, parallel-group trial. Setting Home-based rehabilitation; measurements in university laboratory. Participants Community-dwelling people (N=81) aged ≥60 years recovering from a hip fracture. Participants were randomly assigned to an intervention (n=40) or a control (n=41) group, on average, 42±23 days after discharge from the hospital. Intervention A yearlong intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacologic pain management, a progressive home exercise program, PA counseling, and standard care. Main Outcome Measures The outcome was the level of PA, which was assessed with the questionnaire (a modified Grimby scale) at baseline, and 3, 6, 12, and 24 months after baseline. Three PA categories were defined: inactivity, light PA, and moderate to heavy PA. Physical function was assessed using the Short Physical Performance Battery (SPPB) at baseline. The effects of the intervention were analyzed with generalized estimating equations. Results In the intervention group, a significant increase was observed in the level of PA after the intervention (interaction P=.005) and after 1-year follow-up (P=.021) compared with the standard care only. The benefit was particularly evident among the participants with a baseline SPPB score of ≥7 (interaction P, final draft, peerReviewed

Portegijs E, Edgren J, Salpakoski A, Kallinen M, Rantanen T, Alen M, Kiviranta I, Sihvonen S, Sipila S. Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study. Objective To study the relationship between balance confidence, a concept closely related to fear of falling, mobility and balance performance, and perceived mobility limitation in older people after a fall-related hip fracture. Design Cross-sectional analyses of pretrial data of 2 randomized controlled trials of physical rehabilitation. Setting University research center. Participants Community-dwelling people aged over 60 years, 6 weeks to 7.5 years after a fall-related hip fracture (N=130). Interventions Not applicable. Main Outcome Measures The main outcome was the self-reported Activities-specific Balance Confidence (ABC) scale score. Assessments also included perceived ability to walk outdoors or climb 1 flight of stairs, and assessments of self-preferred walking speed, modified Timed-Up-and-Go test, and Berg Balance Scale. Results Higher ABC scale scores were related to better mobility and balance performance (ρ>.47) and perceived mobility function (ρ>.54). In univariate general linear models, all associations also remained significant after adjustment for age, sex, time since fracture, number of chronic diseases, and either level of physical activity or muscle strength of the fractured leg. An ABC scale score Conclusions In people who have had a fall-related hip fracture, an independent relationship exists between balance confidence and mobility and balance performance as well as perceived mobility function. Since lack of balance confidence may compromise rehabilitation and recovery, the ABC scale may help to identify older hip fracture patients with mobility and balance limitation.

Objective Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture. Design Randomized, controlled, parallel-group trial. Setting Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. Participants Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups. Intervention The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care. Measurements Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention. Results In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were −0.4 points (SE 0.5), −1.7 (0.7), and −1.2 (0.7) at 3, 6, and 12 months for ADLs and −1.0 (1.2), −3.2 (1.5), and −2.5 (1.4) for IADLs, correspondingly. Conclusion The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).