A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). The role of chair exercises for older adults following hip fracture. Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities Back to the future – feasibility of recruitment and retention to patient education and telephone follow-up after hip fracture: a pilot randomized controlled trial Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. Effect of a video intervention on functional recovery following hip replacement and hip fracture repair. Recovery of physical function after limb injuries in independent older people living at home. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia--subgroup analyses of a randomized controlled trial. Effectiveness of a physical exercise intervention program in improving functional mobility in older adults after hip fracture in later stage rehabilitation: protocol of a randomized clinical trial (REATIVE Study) Does standardized rehabilitation and discharge planning improve functional recovery in elderly patients with hip fracture? Physical function and fear of falling after hip fracture rehabilitation in the elderly. Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up. Design and implementation of a home-based exercise program post-hip fracture: the Baltimore hip studies experience.
OBJECTIVES To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan . DESIGN R and omized experimental design . SETTING A 3,800-bed medical center in northern Taiwan . PARTICIPANTS Elderly patients with hip fracture ( N=137 ) were r and omly assigned to an experimental ( n=68 ) or control ( n=69 ) group . INTERVENTION An interdisciplinary program of geriatric consultation , continuous rehabilitation , and discharge planning . MEASUREMENTS Demographic and outcome variables were measured . Outcome variables included service utilization , clinical outcomes , self-care abilities , health-related quality -of-life ( HRQOL ) outcomes , and depressive symptoms . RESULTS Subjects in the experimental group improved significantly more than those in the control group in the following outcomes : ratio of hip flexion 1 month after discharge ( P=.02 ) , recovery of previous walking ability at 1 month ( P=.04 ) and 3 months ( P=.001 ) after discharge , and activities of daily living at 1 month ( P=.01 ) and 2 months ( P=.001 ) after discharge . Three months after discharge , the experimental group showed significant improvement in peak force of the fractured limb 's quadriceps ( P=.04 ) and the following health outcomes : bodily pain ( P=.03 ) , vitality ( P<.001 ) , mental health ( P=.02 ) , physical function ( P<.001 ) , and role physical ( P=.006 ) . They also had fewer depressive symptoms ( P=.008 ) 3 months after discharge . CONCLUSION This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes , self-care abilities , and HRQOL and by decreasing depressive symptoms within 3 months after discharge OBJECTIVES To explore the 2-year outcomes of an interdisciplinary intervention for elderly patients with hip fracture . DESIGN R and omized experimental design . SETTING A 3,000-bed medical center in northern Taiwan . PARTICIPANTS Patients with hip fracture ( N=162 ) : 80 in the intervention group and 82 in the usual care control group .  INTERVENTION An interdisciplinary program of geriatric consultation , continuous rehabilitation , and discharge planning . MEASUREMENTS Outcomes ( clinical outcomes , self-care ability , health-related quality of life ( HRQoL ) , service utilization , and depressive symptoms ) were assessed 1 , 3 , 6 , 12 , 18 , and 24 months after discharge . Self-care ability ( ability to perform activities of daily living ( ADLs ) ) was measured using the Chinese Barthel Index . HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey , Taiwan version ( SF-36 ) . Depressive symptoms were measured using the Chinese Geriatric Depression Scale , short form . RESULTS Subjects in the intervention group had significantly better ratios of hip flexion ( beta=5.43 , P<.001 ) , better performance on ADLs ( beta=9.22 , P<.001 ) , better recovery of walking ability ( odds ratio (OR)=2.23 , P<.001 ) , fewer falls ( OR=0.56 , P=.03 ) , fewer depressive symptoms ( beta=-1.31 , P=.005 ) , and better SF-36 physical summary scores ( beta=6.08 , P<.001 ) than the control group during the first 24 months after discharge . The intervention did not affect the peak force of the fractured limb 's quadriceps , mortality , service utilization , or SF-36 mental summary score . CONCLUSION The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes , self-care ability , and physical health-related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge BACKGROUND Proximal femoral fracture is a major health problem in old age , with annual UK health and social care costs of £ 2.3B . Rehabilitation has the potential to maximise functional recovery and maintain independent living , but evidence of clinical effectiveness and cost-effectiveness is lacking . OBJECTIVES To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive r and omised controlled trial ( RCT ) and economic evaluation . DESIGN Phase I - realist review , survey and focus groups to develop the rehabilitation package . Phase II - parallel-group , r and omised ( using a dynamic adaptive algorithm ) feasibility study with focus groups and an anonymised cohort study . SETTING Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board , North Wales . The intervention was delivered in the community following hospital discharge . PARTICIPANTS Older adults ( aged ≥ 65 years ) who had received surgical treatment for hip fracture , lived independently prior to fracture , had mental capacity ( assessed by the clinical team ) and received rehabilitation in the North Wales area . INTERVENTIONS Participants received usual care ( control ) or usual care plus an enhanced rehabilitation package ( intervention ) . Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital , community hospital and community services depending on need and availability . The intervention was design ed to enhance rehabilitation by improving patients ' self-efficacy and increasing the amount and quality of patients ' practice of physical exercise and activities of daily living . It consisted of a patient-held information workbook , a goal - setting diary and six additional therapy sessions . MAIN OUTCOME MEASURES The primary outcome measure was the Barthel Activities of Daily Living ( BADL ) index . The secondary outcome measures included the Nottingham Extended Activities of Daily Living ( NEADL ) scale , EuroQol-5 Dimensions , ICEpop CAPability measure for Older people , General Self-Efficacy Scale , Falls Efficacy Scale - International ( FES-I ) , Self-Efficacy for Exercise scale , Hospital Anxiety and Depression Scale ( HADS ) and service use measures . Outcome measures were assessed at baseline and at 3-month follow-up by blinded research ers . RESULTS Sixty-two participants were recruited ( 23 % of those who were eligible ) , 61 were r and omised ( control , n = 32 ; intervention , n = 29 ) and 49 ( 79 % ) were followed up at 3 months . Compared with the cohort study , a younger , healthier sub population was recruited . There were minimal differences in most outcomes between the two groups , including the BADL index , with an adjusted mean difference of 0.5 ( Cohen 's d = 0.29 ) . The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group , with an adjusted mean difference between groups of 3.0 ( Cohen 's d = 0.63 ) . There was a trend for greater improvement in FES-I and HADS in the intervention group , but with small effect sizes , with an adjusted mean difference of 4.2 ( Cohen 's d = 0.31 ) and 1.3 ( Cohen 's d = 0.20 ) , respectively . The cost of delivering the intervention was £ 231 per patient . There was a possible small relative increase in quality -adjusted life-years in the intervention group . No serious adverse events relating to the intervention were reported . CONCLUSIONS Trial methods were feasible in terms of eligibility , recruitment and retention , although recruitment was challenging . The NEADL scale was more responsive than the BADL index , suggesting that the intervention could enable participants to regain better levels of independence compared with usual care . This should be tested in a definitive Phase III RCT . There were two main limitations of the study : the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure . TRIAL REGISTRATION Current Controlled Trials IS RCT N22464643 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 44 . See the NIHR Journals Library for further project information OBJECTIVES To examine the influence of regular participation in chair exercises on postoperative deconditioning in respect of selected physiological , psychological and anthropometric variables . DESIGN Quasi-experimental , non-r and omised control group pre-test/post-test design where test group ( N = 20 ) and control group ( N = 10 ) were not equivalent because r and om selection and assignment were not possible . SUBJECTS Patients discharged from an orthopaedic ward 8 - 10 days after hip surgery who were cognitively competent ( mean score on Mini-Mental State Examination 26 ( SD 3.5 ) ) , sedentary ( mean score on Habitual Physical Activity Question naire for the Elderly 7.4 ( SD 3.3 ) ) women aged 70 years and above ( mean 80 ( SD 6.6 ) years ) . SETTING Hip fracture patients admitted to a multidisciplinary geriatric hospital for further medical observation . MEASUREMENTS Abstract ion of medical records provided information about co-morbidities and question naires assessed demographic , affective and cognitive function . Physiological , psychological and anthropometric status was measured pre- and post-intervention . RESULTS Data revealed high variability , suggesting that the effect of the independent variable was obscured by the heterogeneity of the cohort . Both groups improved similarly in grip strength , and in levels of depression and confidence . Body composition data explained the weight maintenance as a consequence of significant gains in fat-free mass in the experimental group . The significant change in systolic blood pressure and heart rate over the exercise and recovery period suggested that the 6-week period of moderate-intensity exercise was adequate to stimulate cardiovascular adaptations . CONCLUSIONS Whether or not the submaximal chair exercise regimen was of optimal benefit remains unclear . However , the intervention did appear to have contributed to the maintenance of the physical condition of older women temporarily disabled as a result of a fracture and subsequent hip surgery Objective : To investigate whether home rehabilitation can improve balance confidence , physical function and daily activity level compared to conventional care in the early phase after hip fracture . Design : A r and omized controlled study . Setting : Geriatric rehabilitation clinic . Subjects : One hundred and two community-dwelling elderly people . Interventions : A geriatric , multiprofessional home rehabilitation programme focused on supported discharge , independence in daily activities , and enhancing physical activity and confidence in performing daily activities was compared with conventional care in which no structured rehabilitation after discharge was included . Main measures : Falls efficacy , degree of dependency and frequency in daily activities , habitual physical activity and basic functional performance . Results : When comparing status one month after discharge with baseline , the home rehabilitation group showed a higher degree of recovery in self-care ( P<0.0001 ) , mobility ( P = 0.002 ) , locomotion ( P = 0.0036 ) and domestic activities ( P = 0.0098 ) , as well as larger increase in balance confidence on stairs ( P = 0.0018 ) and instrumental activities ( mean increase home rehabilitation 19.7 and conventional care 7.1 , P<0.0001 ) compared with the conventional care group . At one month , a majority of the home rehabilitation participants ( 88 % ) took outdoor walks , compared with less than half ( 46 % ) of the conventional care group ( P<0.001 ) and were also more independent in outdoor activities ( P = 0.0014 ) . Conclusions : This study indicates that home rehabilitation , focused on supported discharge and enhancing self-efficacy , improves balance confidence , independence and physical activity in community-dwelling older adults in the early phase after hip fracture Objectives Our primary aim of this pilot study was to test feasibility of the planned design , the interventions ( education plus telephone coaching ) , and the outcome measures , and to facilitate a power calculation for a future r and omized controlled trial to improve adherence to recovery goals following hip fracture . Design This is a parallel 1:1 r and omized controlled feasibility study . Setting The study was conducted in a teaching hospital in Vancouver , BC , Canada . Participants Participants were community-dwelling adults over 60 years of age with a recent hip fracture . They were recruited and assessed in hospital , and then r and omized after hospital discharge to the intervention or control group by a web-based r and omization service . Treatment allocation was concealed to the investigators , measurement team , and data entry assistants and analysts . Participants and the research physiotherapist were aware of treatment allocation . Intervention Intervention included usual care for hip fracture plus a 1-hour in-hospital educational session using a patient-centered educational manual and four videos , and up to five postdischarge telephone calls from a physiotherapist to provide recovery coaching . The control group received usual care plus a 1-hour in-hospital educational session using the educational manual and videos . Measurement Our primary outcome was feasibility , specifically recruitment and retention of participants . We also collected selected health outcomes , including health-related quality of life ( EQ5D-5L ) , gait speed , and psychosocial factors ( ICEpop CAPability measure for Older people and the Hospital Anxiety and Depression Scale ) . Results Our pilot study results indicate that it is feasible to recruit , retain , and provide follow-up telephone coaching to older adults after hip fracture . We enrolled 30 older adults ( mean age 81.5 years ; range 61–97 years ) , representing a 42 % recruitment rate . Participants excluded were those who were not community dwelling on admission , were discharged to a residential care facility , had physician-diagnosed dementia , and /or had medical contraindications to participation . There were 27 participants who completed the study : eleven in the intervention group , 15 in the control group , and one participant completed a qualitative interview only . There were no differences between groups for health measures . Conclusion We highlight the feasibility of telephone coaching for older adults after hip fracture to improve adherence to mobility recovery goals OBJECTIVE To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture . DESIGN AND SUBJECTS A r and omized controlled trial in patients ( n = 199 ) with femoral neck fracture , aged > or= 70 years . METHODS The primary outcomes were : living conditions , walking ability and activities of daily living performance on discharge , 4 and 12 months postoperatively . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation . A geriatric team assessed those in the intervention group 4 months postoperatively , in order to detect and treat any complications . The control group followed conventional postoperative routines . RESULTS Despite shorter hospitalization , significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups ; odds ratios ( 95 % confidence interval ( CI ) ) 2.51 ( 1.00 - 6.30 ) and 3.49 ( 1.31 - 9.23 ) , respectively . More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period , odds ratio ( 95 % confidence interval ) 3.01 ( 1.18 - 7.61 ) . CONCLUSION A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture , from both a short-term and long-term perspective OBJECTIVES To compare outcomes ( physical functions and discharge destinations ) of cognitively impaired and intact older hip fracture patients , and to identify cognitive skills related to functional gains . DESIGN Prospect i ve longitudinal study of hip fracture patients treated on an acute inpatient rehabilitation service , with evaluation of functional performance and living status determined at admission and discharge . SETTING A specialized inpatient geriatric rehabilitation program at Wesley Woods Geriatric Hospital , which is affiliated with Emory University School of Medicine . SUBJECTS Fifty-eight hip fracture patients , 35 with and 23 without cognitive impairment . MEASUREMENTS Cognitive functioning measured by the Mattis Dementia Rating Scale ( MDRS ) ; functional outcome assessed by the Functional Independence Measure ( FIM ) ; comparison of pre-fracture with discharge living environments . MAIN RESULTS Both cognitively impaired and intact hip fracture patients exhibited similar overall FIM motor improvements as well as functional gains in specific FIM areas measuring self-care , sphincter control , and locomotion ( e.g. , walking ) . Cognitively intact patients , however , displayed significantly greater gains in mobility ( e.g. , transfers ) at discharge . Cognitively impaired patients who lived in the community were as likely as intact patients to return to the community . Patients who entered the program at a modified dependence level ( FIM 3 - 5 ) and achieved motor independence  at discharge ( FIM 6 - 7 ) had higher MDRS initiation/ perseveration and memory scores . CONCLUSIONS Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination . Intensive post-fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement . Future research should examine the long-term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome Although much research has documented the functional outcomes in hip repair surgery , few studies have identified effective interventions to improve functional outcomes . The purpose of this study was to test the use of generic and individualized videos on patients ' return to preoperative levels of independent functioning , increased physical performance , improved coping ability , and enhanced perception of ability to care for self .  Two rehabilitation units in separate acute care facilities were used to recruit subjects . Data were collected on 82 participants on admission to the study , on discharge from rehabilitation , 1 week after discharge , and 3 months post discharge . The results indicate that video intervention has some benefit to persons recovering from hip repair surgery . The benefits were realized in physical performance as evidence d by a significant difference in the distance walked and time walked of participants in the treatment group OBJECTIVES to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people . DESIGN prospect i ve cohort study , including a pre-injury assessment and post-injury assessment s at 8 weeks and 5 and 12 months . SETTING the study is part of the larger , population -based prospect i ve and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over , who are living independently in the north of the Netherl and s. SUBJECTS 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessment s ( 66 % of the eligible population ) . Patients were grouped according to injury site . OUTCOME MEASURE self-reported grade s of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale . RESULTS 1 year after the injury , pre-injury ( mean ) levels of functioning were not regained in any of the groups studied . However , only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment . Furthermore , of the 44 subjects with wrist fractures , seven ( 15.9 % ) needed help with at least one relevant activity at baseline and 18 ( 40.9 % ) at 12 months . Of the 34 subjects with hip fractures , four ( 11.8 % ) needed help with at least one activity at baseline and 18 ( 52.9 % ) at 12 months . Practically no changes were found in any of the groups after 5 months post-injury . CONCLUSIONS not only hip fractures , but also wrist fractures may reduce older people 's chances of remaining independent . Prospect s of further recovery are minimal 5 - 6 months after the injury CONTEXT Hip fractures are common in the elderly , and despite st and ard rehabilitation , many patients fail to regain their prefracture ambulatory or functional status . OBJECTIVE To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture . DESIGN , SETTING , AND PATIENTS R and omized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed st and ard physical therapy .  INTERVENTION Participants were r and omly assigned to 6 months of either supervised physical therapy and exercise training ( n = 46 ) or home exercise ( control condition ; n = 44 ) . MAIN OUTCOME MEASURES Primary outcome measures were total scores on a modified Physical Performance Test ( PPT ) , the Functional Status Question naire physical function subscale ( FSQ ) , and activities of daily living scales . Secondary outcome measures were st and ardized measures of skeletal muscle strength , gait , balance , quality of life , and body composition . Participants were evaluated at baseline , 3 months , and 6 months . RESULTS Changes over time in the PPT and FSQ scores favored the physical therapy group ( P = .003 and P = .01 , respectively ) . Mean change ( SD ) in PPT score for physical therapy was + 6.5 ( 5.5 ) points ( 95 % confidence interval [ CI ] , 4.6 - 8.3 ) , and for the control condition was + 2.5 ( 3.7 ) points ( 95 % CI , 1.4 - 3.6 points ) . Mean change ( SD ) in FSQ score for physical therapy was + 5.2 ( 5.4 ) points ( 95 % CI , 3.5 - 6.9 ) and for the control condition was + 2.9 ( 3.8 ) points ( 95 % CI , 1.7 - 4.0 ) . Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength , walking speed , balance , and perceived health but not bone mineral density or fat-free mass . CONCLUSION In community-dwelling frail elderly patients with hip fracture , 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise BACKGROUND People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs Background Hip fractures result ing from falls increase substantially with advancing age and less than half of older hip fracture survivors regain their former levels of mobility . There is increasing evidence that rehabilitation interventions with exercises that goes beyond the sub-acute phase or even in a later stage of care have a positive impact on various functional abilities . The purpose of this study is to determine if exercise program training for people who have suffered a fall-related hip fracture will improve functional mobility when compared with usual care . Methods A r and omized controlled trial with blinded assessors and intention-to-treat analysis will be undertaken . We will recruit 82 older adults , 60 years or over who have suffered a hip fracture due to a fall in the previous 6 to 24 months . Participants r and omized to the Intervention Group ( IG ) will undertake a physical exercise program involving progressive and challenging balance training and neuromuscular and functional training of the lower limbs , conducted at home by physiotherapists , once a week , lasting about one hour , in the first , second and third month after r and omization and will be taught to perform exercises at home , twice a week , using a booklet . Visits to monitor and progress the home exercise program will be conducted once a month , from the fourth to the sixth month and each 2 months until the end of the follow up at the 12th month , i.e. , a total of 18 sessions . Participants will receive monthly phone calls to encourage exercise adherence . The control group will receive usual care . The primary outcome will be mobility-related disability and participants will be assessed at baseline , and at 3 months , 6 and 12 months . Participants will receive monthly phone calls to ask about falls and exercise adherence . Adverse effects will be monitored . Discussion This study proposes a home-based exercise program , which may in part overcome some barriers for rehabilitation , such as difficulties with public transportation and lack of a caregiver to accompany older patients to sessions . If a positive effect is observed this program has the potential to be incorporated into the public health system and contribute to building a pathway of care for older people with hip fracture . Trial registration Clinical trials.gov Identifier : NCT02295527 OBJECTIVE To determine whether st and ardized early rehabilitation and discharge planning increase risk-adjusted function and reduce risk-adjusted institutionalization in the first 6 months after hip fracture . DESIGN Pre-post study of 2 independent population -based inception cohorts . SETTING Two tertiary hospitals in an urban health region . PARTICIPANTS Patients with hip fracture ( N=919 ) 65 years and older . INTERVENTION Subjects were enrolled before ( control ) and after ( intervention ) implementation of st and ardized rehabilitation and discharge planning . MAIN OUTCOME MEASURES Function and institutionalization status were assessed at time of fracture and 3 and 6 months postfracture . Administrative data bases provided length of stay ( LOS ) data . RESULTS After risk-adjustment , the Barthel Index score was significantly lower 3 months postfracture in control patients with low social support compared with those with higher social support ( P<.05 ) . Social support did not affect 3-month function in the intervention cohort . Control subjects with low social support were also significantly more likely to reside in long-term care by 6 months postfracture than intervention subjects with similar social support or those with higher social support ( odds ratio=3.3 ; 95 % confidence interval , 1.4 - 7.5 ) . Total LOS did not change between cohorts . CONCLUSIONS Overall , st and ardized rehabilitation and discharge planning did not affect postoperative function or institutionalization in elderly patients with hip fracture . In intervention patients with low social support , function improved and institutionalization was reduced OBJECTIVE The purpose of this study was to determine the relationship between physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program . DESIGN We used a prospect i ve cohort study over 12 mo to determine the effect of a specialized hip fracture rehabilitation program in a geriatric hospital on physical function and fear of falling . Fifty-six patients were admitted consecutively from acute care . Physical function was assessed using the Functional Independence Measure , and fall-related self-efficacy was measured using two scales : the  Falls-Efficacy scale  and the  Activities-Specific Balance Confidence scale .  We also used the Vitality scale to measure quality of life . All measures , represented by change scores , were determined at the beginning and end of the patients ' rehabilitation programs . RESULTS Significant improvement in physical function and fall self-efficacy was observed . The Vitality scale was also improved after rehabilitation . The Falls-Efficacy scale appeared to be more sensitive to change than the Activities-Specific Balance Confidence scale , whereas no correlation was found between changes in the fall-related self-efficacy measures and the Functional Independence Measure . CONCLUSIONS These findings may represent a discrepancy between attention of the rehabilitation program on functional outcomes and less emphasis on confidence building behaviors . Restrictions in function from a fear of falling may negate any gains made through rehabilitation , and this could limit the long-term success of these programs and patient outcomes after hip fracture OBJECTIVES Few studies describe the trajectories of cognitive function for hip-fracture patients following hospital discharge and the treatment effects of interdisciplinary intervention on cognitive outcomes . The purpose of this study was to explore the 2-year postoperative trajectory for cognitive function of older hip-fracture patients and cognitive effects of an interdisciplinary intervention . METHODS Of 160 subjects r and omly assigned to groups , 29 ( 35.8 % ) in the  control group ( n = 81 ) and 30 ( 38.0 % ) in the  intervention group ( n = 79 ) were cognitively impaired at admission . The intervention group received geriatric consultation , continuous rehabilitation , and discharge planning . Subjects ' cognitive function was measured using the mini mental state examination Taiwan version at admission , 6 , 12 , 18 , and 24 months after discharge and analyzed using hierarchical generalized linear models . RESULTS Patients who received the intervention program had 75 % less likelihood of being cognitively impaired 6 months following discharge than those who received routine care ( odds ratio = 0.25 , p < 0.001 ) . The difference between the control and intervention groups was small at admission , peaked at 18 months , and decreased from 18 to 24 months following discharge . CONCLUSIONS Our interdisciplinary intervention improved the long-term postoperative cognitive functioning of older persons with hip fracture in Taiwan OBJECTIVE The objectives are to describe for the first time a home-based exercise intervention for frail elderly hip fracture patients and to describe the feasibility of this exercise program . DESIGN A home-based exercise program was used in a r and omized controlled trial in which the authors investigated exercise intervention versus no exercise intervention in patients after hip fracture . SETTING This program was implemented at the patients ' own home or place of residence after discharge . PARTICIPANTS Women 65 years of age or older were recruited within 15 days of hip fracture . Eligible patients were those with a nonpathologic fracture who were admitted within 72 hours of injury , had surgical repair of the hip fracture , and met medical inclusion criteria . Participants initially were r and omized to exercise groups and then assigned to exercise trainers . INTERVENTION The exercise contained strength training and aerobic components . Participants were expected to exercise 5 days per week by performing a combination of supervised and independently performed exercise sessions . Intensity and duration were increased gradually by trainers in a st and ardized way . The frequency of the supervised sessions decreased as participants became more independent . Treatment fidelity visits ensured that the intervention was being delivered as intended across trainers and across participants . MAIN OUTCOME MEASUREMENT This work describes the feasibility and challenges of administering an intensive home-based exercise program in this population of older adults . RESULTS Of those patients r and omized to exercise , 82 % were followed by a trainer and almost all advanced to higher levels in both aerobic and strength programs . Overall , participants received an average of 44 ( 78.5 % ) of the prescribed visits by the trainer . CONCLUSIONS This study showed that it was possible to engage a frail older population of post-hip fracture patients in a program of aerobic and strength training exercise with a high rate of participation
Conclusion : Based on available evidence , older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery
Objective : To synthesize evidence on older adults ’  sedentary behavior and physical activity during rehabilitation and recovery for hip fracture ( 1 ) across the care continuum and ( 2 ) from clinical interventions .