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Am Fam Physician. 1998;57(7):1660

Most of the approximately 300,000 persons who sustain hip fractures each year are over 65 years of age. Rehabilitation, which takes place primarily at home, usually fails to restore patients to their prefracture level of function. Tinetti and colleagues evaluated the effectiveness of home-based therapy in elderly patients recovering from hip fractures and assessed whether a home exercise program could be used without injuries to the patients.

Patients were eligible for inclusion in the study if they were at least 65 years of age, had undergone previous surgery for hip fracture, were cognitively intact and lived at home. Of the 148 patients who began the study, 104 completed the six-month program. The physical therapy protocol evaluated and treated balance difficulties, strength, gait, transfers and stair climbing. A physical therapist evaluated patients at home within 48 hours of discharge and then on a regular schedule. The functional therapy protocol focused on identifying and improving unsafe or inefficient performance of activities of daily living (ADLs). A rehabilitation nurse evaluated patients at home within one week of discharge and then on a regular basis, as long as they continued making progress.

Patients using the physical therapy protocol experienced significant improvements in upper and lower extremity strength, higher levels of balance, better categories of transfer performance and excellent progression of stair climbing and gait. Seventy-seven percent of the patients could perform these home exercise programs, and no injuries were reported as a result of this activity. In addition, ADL functioning scores improved with the functional therapy program, and patients were better able to carry out basic functions such as bathing, dressing, preparing meals and toileting at home.

The authors conclude that systematic assessment and intervention protocols provide the basis for a successful home-based therapy program in elderly patients after hip fracture. Protocols that target impairments and ADL function are feasible, safe and effective in improving the functional status of these patients and can help them approach their prefracture abilities.

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Copyright © 1998 by the American Academy of Family Physicians.

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