JOURNAL CLUB

AYUSHI JAIN
PROGRESSIVE STRENGTH TRAINING IN OLDER
PATIENTS AFTER HIP FRACTURE
o Randomised controlled trial – Level 2 quality of evidence
o Relevant to our target population >65 years and post hip fracture
o Pedro scale: 8/10
o Large sample size of 150 patients
o 3 month strength training program
o Recently published: 2011
KEY AIMS OF ARTICLE

• To assess the effect of a 3-month strength-training program on functional performance

and self-rated health in a group of older hip fracture patients
• Outcome measures: strength, balance, mobility, activities of daily living and self rated
health
METHOD

• Study design: Patients from the hospital were approached during their stay at hospital.
After 12 weeks, they were randomised in a 2:1 manner to either an intervention or control
group.
• Reasoning: allow further studies on the intervention group
• Thoughts?
STUDY POPULATION

• Inclusion criteria: >65 years old, femoral neck or trochanteric fracture, living at home,
able to undergo physiotherapy for the fracture, 23/30 on the mini-mental state
examination
• Exclusion criteria: Living in a nursing home, metastic cancer is the reason for the
fracture, remaining life expectancy <6 months, multi-trauma #
• Randomisation method: patients were randomly assigned by a computer generated list to
the intervention or controlled group. Randomisation performed using sealed opaque
envelopes.
OUTCOME MEASURES

• Berg balance scale

• Sit to stand test: timed x10 STS
• Timed up and go
• Maximal gait speed
• Maximum step height
• 6 minute walk test
• Nottingham extended ADL’s score: out of 66, higher score indicates better functioning in
ADL’s
• Short form – 12 test: self related health (physical and mental domain)
INTERVENTION

• Group and individual sessions

• One repetition maximum (1RM) strength measured for knee flexion and extension. Repeated
every 3 weeks
• Before testing: All participants were exercised on a stationary bike or treadmill
• Exercise session for 45-60 min
• Exercises: standing knee flexion, lunge, sitting knee extension and leg extension
• 3 sets of 15 of each exercise at 70% of 1RM. Increased to 80% after first 3 weeks. Resistance
progressively increased every 3 weeks according to 1RM measurement.
• Repetitions reduced. Why?
RESULTS

• Significant improvements in berg balance scale, STS test, 6MWT, timed up and go
compared to control group
• Maximal gait speed and self-rated health (SF-12) did not improve.
• Why??
SUMMARY

• Pros:
• Cons: