Archives of physical medicine and rehabilitation | 2021
Effects of home-based physical exercise on days at home, healthcare utilization and functional independence among patients with hip fractures: a randomized controlled trial.
Abstract
OBJECTIVE\nTo evaluate the effects of a physical exercise program on days lived at home, the use and costs of healthcare and social services mortality and functional independence among patients with hip fractures.\n\n\nDESIGN\nRandomized controlled trial with parallel two-group design, consisting of a 12-month intervention and 12-month registry follow-up.\n\n\nSETTING\nHome-based intervention.\n\n\nPARTICIPANTS\nPatients with operated hip fracture, living at home, aged ≥60\u2005years, randomized into physical-exercise (n=61) or usual-care (n=60) groups.\n\n\nINTERVENTION\nSupervised physical exercise twice a week.\n\n\nMAIN OUTCOME MEASURES\nThe primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of healthcare and social services and mortality over 24 months, and Functional Independence Measure (FIM) over 12 months.\n\n\nRESULTS\nOver 24 months there was no significant difference between the groups in terms of days lived at home (Incidence Rate Ratio [IRR] 1.01 [95% CI 0.90-1.14]) or mortality (Hazard Ratio [HR] 1.01 [95% CI 0.42-2.43]). The mean total costs of healthcare and social services did not differ between the groups: over 12 months the costs per person-year were 1.26-fold (95% CI 0.87-1.86) and over 24 months 1.08-fold (95% CI 0.77-1.70) greater in the physical-exercise than in the usual-care group. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI 0.5-8.5, p=0.029) in favor of the physical-exercise group.\n\n\nCONCLUSIONS\nLong-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but significantly more in the physical-exercise group than in the usual-care group.