Early Strength Training After Hip Fracture Surgery

Feasibility of Progressive Strength Training in the Early Post Surgical Rehabilitation Period After Hip Fracture Surgery

Patients treated surgically for a hip fracture have a need of rehabilitation for the regain of former functional skills. Despite an optimized fast track in-hospital rehabilitation program it has been found that patients with hip fracture within 2 weeks after the hip fracture loose more than half of their muscle strength in the fractured limb compared to non-fractured limb. New studies including patients with total hip arthroplasty and strength training applied early after surgery has shown promising results regarding prevention of loss of muscle strength. No similar study has been found including patients with hip fracture.

The purpose of this study is to examine the feasibility of progressive knee-extension strength training of the hip fractured limb, starting Day 1 after surgical treatment for a hip fracture and proceeded every weekday during their hospital stay.

The study will include 20 patients surgically treated for a cervical hip fracture and 20 patients surgically treated for an intertrochanteric or subtrochanteric fracture. All patients are admitted from their own home. Age 60 years or older.

Study Overview

• Status: Completed
• Conditions: Hip Fractures
• Intervention / Treatment: Other: Knee-extension strength training of the fractured limb

Detailed Description

Kronborg L, Bandholm T, Palm H, Kehlet H, Kristensen MT (2014) Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery. PLoS ONE 9(4): e93332. doi:10.1371/journal.pone.0093332

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Hvidovre, Denmark, 2650
    • Copenhagen University Hospital, Hvidovre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Hip fracture diagnosed patients age ≥60 years, admitted to the acute hip fracture unit.
• Medial femoral neck fracture, pertrochanteric fracture or subtrochanteric fracture.
• Ability to speak and understand the Danish language.
• Cognitively well-preserved and able to give personal informed consent no later than by 5th post surgical day.
• Home-residing and with an independent pre-fracture ability to walk equal to New Mobility Score at ≥ 2 indoor.

Exclusion Criteria:

• Multiple fractures
• Postsurgical restrictions of mobilization
• Patient not accepting participation in relevant exercise therapy
• Fracture caused by cancer metastases
• Terminal illness
• Neurological impairment e.g. hemi paresis.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Strength training, fractured limb; Knee-extension strength training of the fractured limb: Daily knee-extension strength training with 3 x 10 repetitions using an intensity of 10 Repetition Maximum (RM) for the hip fractured limb started as soon as possible after surgery.	Other: Knee-extension strength training of the fractured limb; Daily knee-extension strength training with 3 x 10 repetitions using an intensity of 10 Repetition Maximum (RM) for the hip fractured limb started as soon as possible after surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of progression in training loads (kg) during daily knee-extension strength training when commenced immediately after hip fracture surgery.	Feasibility is evaluated on the basis of adherence to program, adverse events, target training intensity, hip pain during training and other potential restricting factors, e.g. confusion, exhaustion and dropouts.	Baseline to discharge, in average 10 days.

Secondary Outcome Measures

Outcome Measure	Time Frame
Change in maximum isometric knee-extension strength and strength deficits, fractured % of non-fractured limb measured by handheld dynamometer.	Baseline to discharge, in average 10 days.

Other Outcome Measures

Outcome Measure	Time Frame
Association between 10 meter fast speed walk and knee-extension strength discharge from hospital.	Day before discharge from hospital.

Collaborators and Investigators

• Sponsor: Copenhagen University Hospital, Hvidovre
• Investigators: Study Director: Morten T Kristensen, PhD, Copenhagen University Hospital at Hvidovre, Denmark

Publications and helpful links

General Publications

• Kronborg L, Bandholm T, Palm H, Kehlet H, Kristensen MT. Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery. PLoS One. 2014 Apr 3;9(4):e93332. doi: 10.1371/journal.pone.0093332. eCollection 2014.

Study record dates

Study Major Dates

• Study Start: June 1, 2012
• Primary Completion (Actual): March 1, 2013
• Study Completion (Actual): March 1, 2013

Study Registration Dates

• First Submitted: June 5, 2012
• First Submitted That Met QC Criteria: June 7, 2012
• First Posted (Estimate): June 11, 2012

Study Record Updates

• Last Update Posted (Estimate): May 15, 2014
• Last Update Submitted That Met QC Criteria: May 14, 2014
• Last Verified: May 1, 2014

More Information

Terms related to this study

• Keywords: Hip fractures; Strength training
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: HH-S-1