Background
Method
Participants
Functional outcome measures
Statistical analyses
Results
Participants
Women (n = 130) | Men (n = 30) | Mean differences (95% CI) or chi squared, p | |
---|---|---|---|
Group (HIGH:LOW) | 65:65 | 15:15 | - |
Age at fracture (years), mean (SD) | 84.4 (6.7) | 81.7 (10.6) | 2.7 (-0.4 to 5.7), 0.083 |
Height (cm), mean (SD) | 157.6 (7.7) | 168.3 (14.5) | -10.7 (-14.4 to -7.0), p < 0.01
|
Mass (kg), mean (SD) | 58.5 (12.0) | 67.8 (15.0) | -9.3 (-14.4 to -4.3), p < 0.01
|
Pre-fracture Barthel Index, mean (SD) | 93.9 (9.0) | 96.2 (9.3) | -2.3 (-5.9 to 1.4), 0.217 |
Pre-fracture falls, mean (SD) | 1.7 (1.5) | 2.3 (2.3) | -0.6 (-1.3 to 0.0), 0.066 |
Pre-fracture co-morbidities, mean (SD) | 3.8 (1.8) | 4.1 (2.1) | -0.3 (-1.1 to 0.4), 0.384 |
Pre-fracture services, mean (SD) | 1.1 (1.4) | 1.1 (1.3) | 0.1 (-0.5 to 0.6), 0.859 |
Medications, mean (SD) | 6.7 (2.7) | 5.8 (2.5) | 0.9 (-0.2 to 2.0), 0.094 |
Hostel dwelling, n (%) | 28 (21.5) | 1 (3.3) | 5.4, p = 0.020
|
Type of pre-fracture walking aid, | |||
No aids or using walking stick or crutches, n (%) | 104 (80) | 26 (86.7) | 0.7, p = 0.399 |
All other aids, n (%) | 26 (20) | 4 (13.3) | |
Left hip fracture, n (%) | 77 (59.2) | 18 (60) | 0.006, p = 0.938 |
Type of fracture, | |||
Intra-capsular, n (%) | 63 (49.2)* | 15 (50) | 0.006, p = 0.939 |
Trochanteric, n (%) | 65 (50.8)* | 15 (50) | |
Type of surgery, | |||
Bone screw, plate or other, n (%) | 79 (60.8) | 17 (56.7) | 0.1, p = 0.738 |
Arthroplasty, n (%) | 51 (39.2) | 13 (43.3) | |
Short Portable Mental Status Questionnaire ≥3 adjusted errors, n (%) | 48 (36.9) | 6 (20) | 3.2, p = 0.077 |
Outcomes
Baseline (n = 160) | Week 4 (n = 158) | Week 4-baseline (n = 158) | Week 16 (n = 150) | Week 16-baseline (n = 150) | |
---|---|---|---|---|---|
Strength measures
| |||||
Knee extensor strength, kg | 1.0 (-0.4 to 2.3), 0.151†
| 2.1 (0.6 to 3.7), 0.008
†
| 1.8 (0.3 to 3.2), 0.020
†
| 1.8 (-0.2 to 3.8), 0.070†
| 1.4 (-0.5 to 3.3), 0.149†
|
Mobility measures
| |||||
Walk speed, m/s | 0.04 (-0.04 to 0.1), 0.332 | 0.04 (-0.05 to 0.1), 0.387 | 0.02 (-0.06 to 0.1), 0.634 | 0.06 (-0.7 to 0.2), 0.364 | 0.02 (-0.1 to 0.1), 0.726 |
PPME | -0.2 (-0.9 to 0.5), 0.555 | 0.5 (-0.3 to 1.2), 0.226†
| 0.6 (-0.1 to 1.3), 0.100†
| 0.4 (-0.6 to 1.4), 0.448†
| 0.4 (-0.5 to 1.4), 0.383†
|
Barthel index | 3.4 (-2.1 to 8.9), 0.224†
| 1.5 (-3.6 to 6.7), 0.562†
| 0.4 (-4.4 to 5.2), 0.881†
| 2.4 (-3.9 to 8.6), 0.457†
| 1.0 (-4.7 to 6.8), 0.720†
|
Sit to stand, stand-ups/sec | 0.01 (-0.02 to 0.04), 0.434†
| -0.007 (-0.6 to 0.5), 0.797 | -0.01 (-0.06 to 0.04), 0.591 | -0.03 (-0.09 to 0.02), 0.259 | -0.05 (-0.1 to 0.004), 0.071 |
No aids, using walking stick or crutches* | 2.1 (0.6 to 7.2), 0.255†
| 2.0 (0.9 to 4.4), 0.109†
| 1.8 (0.7 to 4.5), 0.206†
| 2.0 (0.8 to 5.2), 0.140†
| 1.9 (0.7 to 4.8), 0.205†
|
Balance measures
| |||||
Maximum balance range, mm | 4.2 (-10.5 to 18.9), 0.572†
| 4.6 (-11.9 to 21.1), 0.584†
| 2.7 (-12.9 to 18.2), 0.735†
| 12.2 (-7.2 to 31.6), 0.217†
| 8.9 (-9.7 to 27.5), 0.343†
|
Body sway total, mm | 29.5 (-55.9 to 115), 0.496 | 21.5 (-61.1 to 104), 0.608 | 10.0 (-65.1 to 85.0), 0.793 | -6.6 (-86.9 to 73.7), 0.872†
| -8.1 (-78.8 to 62.7), 0.822†
|
Step test | -0.4 (-1.2 to 0.4), 0.337 | 0.3 (-1.6 to 2.2), 0.733†
| 0.5 (-1.4 to 2.4), 0.622†
| -0.5 (-2.5 to 1.6), 0.661 | -0.5 (-2.5 to 1.7), 0.675 |
Lateral stability, mm | 4.9 (-3.5 to 13.3), 0.247 | -0.5 (-9.8 to 8.8), 0.916†
| -1.9 (-11.0 to 7.1), 0.671†
| 4.7 (-3.8 to 13.2), 0.278 | 3.0 (-5.1 to 11.0), 0.462 |
Coordinated stability | -4.8 (-12.0 to 2.5), 0.194†
| -10.0 (-17.6 to -2.4), 0.010
†
| -6.7 (-12.4 to -1.0), 0.023
†
| -10.2 (-18.4 to -1.9), 0.016
†
| -6.3 (-13.1 to 0.6), 0.074†
|
Choice stepping reaction time, sec | N/A | -600 (-1484 to 285), 0.182†§
| N/A | -400 (-1375 to 574), 0.418†‡
| N/A |
Baseline (n = 160) | Week 4 (n = 158) | Week 4-baseline (n = 158) | Week 16 (n = 150) | Week 16-baseline (n = 150) | |
---|---|---|---|---|---|
Self-rated mobility as good* | 1.2 (0.5 to 3.4), 0.690†
| 1.0 (0.5 to 2.4), 0.940†
| 1.0 (0.4 to 2.3), 0.999†
| 0.5 (0.2 to 1.1), 0.082†∫
| 0.5 (0.2 to 1.1), 0.078†∫
|
Self-rated strength as good* | 0.8 (0.2 to 2.4), 0.632†
| 0.4 (0.1 to 1.3), 0.136†
| 0.4 (0.1 to 1.4), 0.155†
| 0.6 (0.3 to 1.5), 0.310†∫
| 0.7 (0.3 to 1.7), 0.387†∫
|
Self-rated balance as good* | 0.9 (0.4 to 2.0), 0.718†
| 1.0 (0.4 to 2.4), 0.940†
| 1.0 (0.4 to 2.6), 0.953†
| 0.8 (0.3 to 1.9), 0.611†∫
| 0.9 (0.4 to 2.0), 0.711†∫
|
Self-rated pain as none or slight* | 0.8 (0.3 to 1.9), 0.602†
| 0.7 (0.3 to 1.6), 0.450†
| 0.8 (0.3 to 1.7), 0.505†
| 1.0 (0.4 to 2.5), 0.920†
| 1.1 (0.5 to 2.6), 0.887†
|
Self-rated health as worse* | 1.0 (0.4 to 2.1), 0.899 | 0.9 (0.4 to 2.0), 0.772§
| 0.9 (0.4 to 2.0), 0.785§
| 0.7 (0.3 to 1.9), 0.476∫
| 0.8 (0.3 to 2.1), 0.605∫
|
Modified falls efficacy scale | 10.3 (-2.3 to 22.8), 0.109†‡
| 8.4 (-3.8 to 20.7), 0.174†§
| 3.7 (-7.3 to 14.6), 0.507†ǁ
| 4.7 (-9.8 to 19.3), 0.520†∫
| -0.7 (-13.8 to 12.4), 0.916†** |
EQ5D | 0.02 (-0.09 to 0.1), 0.765 | 0.04 (-0.07 to 0.2), 0.510 | 0.03 (-0.07 to 0.1), 0.535 | -0.03 (-0.2 to 0.09), 0.610†∫
| -0.04 (-0.2 to 0.08), 0.529†∫
|
Baseline (n = 160) | Week 4 (n = 158) | Week 4-baseline (n = 158) | Week 16 (n = 150) | Week 16-baseline (n = 150) | |
---|---|---|---|---|---|
Knee extensor strength, kg
| |||||
Cognition | -1.0 (-2.1 to 0.1), 0.073 | -1.0 (-2.3 to 0.3), 0.137 | -0.6 (-1.9 to 0.6), 0.322 | -1.1 (-2.7 to 0.5), 0.180 | -0.6 (-2.2 to 0.9), 0.417 |
Cognition controlling for gender | -0.9 (-2.0 to 0.2), 0.108 | -0.8 (-2.1 to 0.5), 0.244 | -0.5 (-1.7 to 0.8), 0.468 | -0.9 (-2.5 to 0.7), 0.245 | -0.5 (-2.1 to 1.0), 0.493 |
Gender controlling for cognition and age | 0.9 (-0.5 to 2.2), 0.216 | 1.9 (0.3 to 3.5), 0.018
| 1.6 (0.09 to 3.1), 0.038
| 1.4 (-0.5 to 3.4), 0.154 | 1.0 (-0.9 to 2.9), 0.287 |
Coordinated stability
| |||||
Cognition | 6.4 (0.4 to 12.3), 0.036
| 11.7 (5.5 to 17.9), 0.000
| 7.4 (2.6 to 12.1), 0.003
| 9.0 (2.4 to 15.5), 0.008
| 4.9 (-0.6 to 10.4), 0.080 |
Age | 0.6 (0.3 to 1.0), 0.001
| 0.9 (0.5 to 1.2), 0.000
| 0.4 (0.1 to 0.7), 0.006
| 0.7 (0.4 to 1.1), 0.000
| 0.4 (0.03 to 0.7), 0.035
|
Cognition controlling for gender | 5.9 (-0.07 to 11.9), 0.053 | 10.8 (4.7 to 17.0), 0.001
| 6.8 (2.1 to 11.6), 0.005
| 8.2 (1.7 to 14.7), 0.014
| 4.5 (-1.0 to 10.0), 0.105 |
Age controlling for gender | 0.6 (0.3 to 1.0), 0.001
| 0.8 (0.4 to 1.2), 0.000
| 0.4 (0.09 to 0.7), 0.011
| 0.7 (0.3 to 1.1), 0.001
| 0.3 (-0.003 to 0.7), 0.052 |
Gender controlling for cognition | -3.8 (-11.1 to 3.5), 0.304 | -8.3 (-15.7 to -0.8), 0.029
| -5.7 (-11.3 to -0.08), 0.047
| -9.1 (-17.2 to -1.0), 0.029
| -5.8 (-12.6 to 1.1), 0.097 |
Gender controlling for age | -3.1 (-10.2 to 4.0), 0.387 | -7.9 (-15.2 to -0.6), 0.034
| -5.8 (-11.5 to -0.2), 0.043
| -8.2 (-16.2 to -0.2), 0.045
| -5.5 (-12.4 to 1.3), 0.112 |
Gender controlling for cognition and age | -2.5 (-9.6 to 4.6), 0.488 | -6.7 (-13.8 to 0.5), 0.066 | -5.1 (-10.7 to 0.5), 0.073 | -7.5 (-15.5 to 0.4), 0.063 | -5.2 (-12.0 to 1.6), 0.135 |