Effect of Multicomponent Home-Based Training on Gait and Muscle Strength Performance in Older Adults With Hip Fracture

Research Objectives To investigate the effect of a specific multicomponent home-based physical therapy intervention on gait and muscle strength. Design Single-blinded randomized controlled trial. Setting General community. Participants Thirty-four older adults post hip fracture were randomly assigned to either experimental group (n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or control group (n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). Interventions Experimental group received multi-component home-based physical therapy focused on lower extremity strength, endurance, balance, and function for community ambulation; control group received non-specific multi-component home-based physical therapy including active joint movement and TENS. Both groups received 32-40 training sessions for 16 weeks. Main Outcome Measures Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16-weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. Results At 16-weeks, both groups demonstrated a significant increase in usual walking speed (experimental group: 0.15m/s [95%CI: 0.02-0.27], p=0.003; control group: 0.17m/s [95%CI: 0.03-0.31], p=0.002). Knee extensor normalized peak torque (fractured side) increased in the experimental group (difference 0.9% [0.0% to 1.7%], p=0.001). However, there were no significant differences in time-course change between the groups for measured outcomes. The increase in usual walking speed correlated with the baseline TMT-B score (r=-0.371, p=0.037), and an increase in fast walking speed was associated with improved muscle strength in the fractured limb (r=0.446, p=0.001). However, those correlations diminished when adjusted by age. Conclusions Specific home-based multicomponent physical therapy is associated with improved muscle strength and gait speed in older adults after hip fracture surgery. Intervention targeting modifiable factors such as cognition and muscle strength may assist gait recovery after hip fracture surgery.