How Much More Therapy Should Elderly Patients Get?

While no surgeon thinks that an 80-year-old who breaks her hip will be completely back to normal after rehab, that person may achieve greater levels of functioning than many are expecting of her.

New work to better understand the link between quantity of therapy and quality of life post-operatively is the subject of a new paper, “Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial,” was published in the September 10, 2019 edition of JAMA Network.

Co-author Kathleen Mangione, P.T., Ph.D., with the Department of Physical Therapy, College of Health Sciences, Arcadia University in Glenside, Pennsylvania, explained the purpose of her study to OTW, “Many patients after hip fracture still are not returning to their prior level of function after hip fracture. They transition from hospital to subacute rehab to home, but physical therapy stops for many of them once they are independent in the home.”

The research, conducted at Arcadia University, University of Connecticut Health Center, and University of Maryland, involved a total of 210 patients aged 60 years and older. The training intervention group (n = 105) received aerobic, strength, balance, and functional training. The active control group (n = 105) received transcutaneous electrical nerve stimulation and active range-of-motion exercises. Both groups received 2 to 3 home visits from a physical therapist weekly for 16 weeks; nutritional counseling; and daily vitamin D, calcium, and multivitamins.

“Both groups improved by clinically meaningful amounts with additional therapy.” Said Mangione. “There is room for clinically important improvement in patients even three months after fracture. We need to determine whether patients have reached their full potential for recovery prior to discharge.”

“Since patients showed meaningful improvements with additional physical therapy after the traditional acute and sub-acute phase of recovery, surgeons could encourage patients to ‘not settle’ for their current state of function, but rather continue to pursue physical therapy and exercise programs so they can achieve higher levels of function.”