Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities Walking tolerance of patients recovering from hip fracture: a phase I trial Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial. Effectiveness of a physical exercise intervention program in improving functional mobility in older adults after hip fracture in later stage rehabilitation: protocol of a randomized clinical trial (REATIVE Study) Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial Physical function and fear of falling after hip fracture rehabilitation in the elderly. Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese. Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women. Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. The role of chair exercises for older adults following hip fracture. Reducing Sedentary Behavior Versus Increasing Moderate-to-Vigorous Intensity Physical Activity in Older Adults Effect of a video intervention on functional recovery following hip replacement and hip fracture repair. Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status. Pressure ulcers in elderly patients with hip fracture across the continuum of care. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study) Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial.
Background Patients admitted to the intensive care unit with critical illness often experience significant physical impairments , which typically persist for many years following resolution of the original illness . Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit , following discharge to the ward and beyond hospital discharge . Multiple systematic review s have been published appraising the exp and ing evidence investigating these physical rehabilitation interventions , although there appears to be variability in review methodology and quality . We aim to conduct an overview of existing systematic review s of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery . Methods / design This protocol has been developed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol ( PRISMA -P ) guidelines . We will search the Cochrane Systematic Review Data base , Data base of Abstract s of Review s of Effectiveness , Cochrane Central Register of Controlled Trials , MEDLINE , Excerpta Medica Data base and Cumulative Index to Nursing and Allied Health Literature data bases . We will include systematic review s of r and omised controlled trials of adult patients , admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery . Data extraction will include systematic review aims and rationale , study types , population s , interventions , comparators , outcomes and quality appraisal method . Primary outcomes of interest will focus on findings reflecting recovery of physical function . Quality of reporting and method ological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Review s tool . Discussion We anticipate the findings from this novel overview of systematic review s will contribute to the synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery . Systematic review registration PROSPERO CRD42015001068 Objective : To investigate whether home rehabilitation can improve balance confidence , physical function and daily activity level compared to conventional care in the early phase after hip fracture . Design : A r and omized controlled study . Setting : Geriatric rehabilitation clinic . Subjects : One hundred and two community-dwelling elderly people . Interventions : A geriatric , multiprofessional home rehabilitation programme focused on supported discharge , independence in daily activities , and enhancing physical activity and confidence in performing daily activities was compared with conventional care in which no structured rehabilitation after discharge was included . Main measures : Falls efficacy , degree of dependency and frequency in daily activities , habitual physical activity and basic functional performance . Results : When comparing status one month after discharge with baseline , the home rehabilitation group showed a higher degree of recovery in self-care ( P<0.0001 ) , mobility ( P = 0.002 ) , locomotion ( P = 0.0036 ) and domestic activities ( P = 0.0098 ) , as well as larger increase in balance confidence on stairs ( P = 0.0018 ) and instrumental activities ( mean increase home rehabilitation 19.7 and conventional care 7.1 , P<0.0001 ) compared with the conventional care group . At one month , a majority of the home rehabilitation participants ( 88 % ) took outdoor walks , compared with less than half ( 46 % ) of the conventional care group ( P<0.001 ) and were also more independent in outdoor activities ( P = 0.0014 ) . Conclusions : This study indicates that home rehabilitation , focused on supported discharge and enhancing self-efficacy , improves balance confidence , independence and physical activity in community-dwelling older adults in the early phase after hip fracture Abstract Purpose : To find out how much physical activity in the form of walking can be tolerated by adults admitted for inpatient rehabilitation after hip fracture . Method : Using a phase I dose – response design , in addition to usual scheduled rehabilitation care  participants without cognitive impairment were supervised to walk for a prescribed length of time on 5 consecutive days . Doses started at 3 min and were escalated when three participants successfully completed a dose . Secondary outcomes included physical activity and the Ambulatory Self-Confidence Question naire ( ASCQ ) . Results : The maximum tolerated dose of  walking  for the 13 participants ( 4 men and 9 women ; mean age 81 years , SD 10 ) was 6 min . At 10 min only 1 of 5 participants was able to complete the dose . The main reason for not tolerating the prescribed dose was fatigue . Participants had relatively low levels of daily physical activity ( mean 507 steps/day ) , and lacked confidence in their walking ( ASCQ mean 4.6 ) . Conclusion : Physical activity guidelines for older people are not appropriate for patients in active inpatient rehabilitation recovering from hip fracture where other factors such as fatigue may limit physical activity levels . These results can be taken into account when design ing rehabilitation programmes after hip fracture . Implication s for Rehabilitation Hip fracture is a common and serious fracture with ongoing disability for which people require inpatient rehabilitation to prepare for return to independent living in the community . The maximum tolerated dose of walking of 6 minutes suggests physical activity guidelines for older people are not applicable for those receiving active inpatient rehabilitation after hip fracture . The maximum tolerated dose of walking of 6 minutes during inpatient rehabilitation suggests rehabilitation programmes be structured to allow adequate time for recovery OBJECTIVE To determine whether a home-based systematic multicomponent rehabilitation strategy leads to improved outcomes relative to usual care . DESIGN A r and omized controlled trial with 12 months of follow-up . SETTING General community ; 27 home care agencies . PARTICIPANTS Three hundred four nondemented persons at least 65 years of age who underwent surgical repair of a hip fracture at two hospitals in New Haven , CT , and returned home within 100 days . INTERVENTION Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments ( physical therapy ) and activities of daily living ( ADL ) disabilities ( functional therapy ) versus usual care . MAIN OUTCOME MEASURES A battery of self-report and performance-based measures of physical and social function . RESULTS There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months ( 71 % vs 75 % ) or 12 months ( 74 % in both groups ) or in home management ADL at 6 months ( 35 % vs 44 % ) or 12 months ( 44 % vs 48 % ) . There also was no difference between the two groups in social activity levels , two timed mobility tasks , balance , or lower extremity strength at either 6 or 12 months . Compared with participants who received usual care , those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months ( p = .04 ) and a marginally better gait performance ( p = .08 ) . CONCLUSIONS The systematic multicomponent rehabilitation program was no more effective in promoting recovery than usual home-based rehabilitation . Compared with previous cohorts , however , participants r and omized to usual care in our study received more rehabilitative and home care services and experienced a higher rate of recovery . This finding is important given the current pressures to reduce home services . The challenge is to determine the composition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fracture Background Hip fractures result ing from falls increase substantially with advancing age and less than half of older hip fracture survivors regain their former levels of mobility . There is increasing evidence that rehabilitation interventions with exercises that goes beyond the sub-acute phase or even in a later stage of care have a positive impact on various functional abilities . The purpose of this study is to determine if exercise program training for people who have suffered a fall-related hip fracture will improve functional mobility when compared with usual care . Methods A r and omized controlled trial with blinded assessors and intention-to-treat analysis will be undertaken . We will recruit 82 older adults , 60 years or over who have suffered a hip fracture due to a fall in the previous 6 to 24 months . Participants r and omized to the Intervention Group ( IG ) will undertake a physical exercise program involving progressive and challenging balance training and neuromuscular and functional training of the lower limbs , conducted at home by physiotherapists , once a week , lasting about one hour , in the first , second and third month after r and omization and will be taught to perform exercises at home , twice a week , using a booklet . Visits to monitor and progress the home exercise program will be conducted once a month , from the fourth to the sixth month and each 2 months until the end of the follow up at the 12th month , i.e. , a total of 18 sessions . Participants will receive monthly phone calls to encourage exercise adherence . The control group will receive usual care . The primary outcome will be mobility-related disability and participants will be assessed at baseline , and at 3 months , 6 and 12 months . Participants will receive monthly phone calls to ask about falls and exercise adherence . Adverse effects will be monitored . Discussion This study proposes a home-based exercise program , which may in part overcome some barriers for rehabilitation , such as difficulties with public transportation and lack of a caregiver to accompany older patients to sessions . If a positive effect is observed this program has the potential to be incorporated into the public health system and contribute to building a pathway of care for older people with hip fracture . Trial registration Clinical trials.gov Identifier : NCT02295527 Background Health-related quality of life ( HRQoL ) has been used to assess subjects ’ prognosis and recovery following hip fracture . However , evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture . The purpose s of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery . Methods For this secondary analysis , data came from a r and omized controlled trial of subjects with hip fracture receiving three treatment care models : interdisciplinary care ( n = 97 ) , comprehensive care ( n = 91 ) , and usual care ( n = 93 ) .  Interdisciplinary care consisted of geriatric consultation , discharge planning , and 4 months of in-home rehabilitation . Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms , fall prevention , and 12 months of in-home rehabilitation . Usual care included only in-hospital rehabilitation and occasional discharge planning , without geriatric consultation and in-home rehabilitation .  Mental and physical HRQoL were measured at 1 , 3 , 6 , and 12 months after discharge by the physical component summary scale ( PCS ) and mental component summary scale ( MCS ) , respectively , of the Medical Outcomes Study Short Form 36 , Taiwan version . Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models . Results We identified three quadratic PCS trajectories : poor PCS ( n = 103 , 36.6 % ) , moderate PCS ( n = 96 , 34.2 % ) , and good PCS ( n = 82 , 29.2 % ) . In contrast , we found three linear MCS trajectories : poor MCS ( n = 39 , 13.9 % ) , moderate MCS ( n = 84 , 29.9 % ) , and good MCS ( n = 158 , 56.2 % ) . Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory ( b = 0.99 , odds ratio [ OR ] = 2.69 , confidence interval [ CI ] = 7.24–1.00 , p = 0.049 , and b = 1.32 , OR = 3.75 , CI = 10.53–1.33 , p = 0.012 , respectively ) than those who received usual care . However , neither care model improved MCS . Conclusions The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects ’ odds for following a trajectory of good physical functioning after hospitalization . Trial registration Clinical Trials.gov ( NCT01350557 OBJECTIVE The purpose of this study was to determine the relationship between physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program . DESIGN We used a prospect i ve cohort study over 12 mo to determine the effect of a specialized hip fracture rehabilitation program in a geriatric hospital on physical function and fear of falling . Fifty-six patients were admitted consecutively from acute care . Physical function was assessed using the Functional Independence Measure , and fall-related self-efficacy was measured using two scales : the  Falls-Efficacy scale  and the  Activities-Specific Balance Confidence scale .  We also used the Vitality scale to measure quality of life . All measures , represented by change scores , were determined at the beginning and end of the patients ' rehabilitation programs . RESULTS Significant improvement in physical function and fall self-efficacy was observed . The Vitality scale was also improved after rehabilitation . The Falls-Efficacy scale appeared to be more sensitive to change than the Activities-Specific Balance Confidence scale , whereas no correlation was found between changes in the fall-related self-efficacy measures and the Functional Independence Measure . CONCLUSIONS These findings may represent a discrepancy between attention of the rehabilitation program on functional outcomes and less emphasis on confidence building behaviors . Restrictions in function from a fear of falling may negate any gains made through rehabilitation , and this could limit the long-term success of these programs and patient outcomes after hip fracture Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors . Despite an explosion of mobile phone applications aim ed at physical activity and other health behaviors , few have been based on theoretically derived constructs and empirical evidence . Eighty adults ages 45 years and older who were insufficiently physically active , engaged in prolonged daily sitting , and were new to smartphone technology , participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence . An “ analytically ” framed custom application focused on personalized goal setting , self-monitoring , and active problem solving around barriers to behavior change . A “ socially ” framed custom application focused on social comparisons , norms , and support . An “ affectively ” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar , whose movements and behaviors reflected the physical activity and sedentary levels of the user . To explore the applications ' initial efficacy in changing regular physical activity and leisure-time sitting , behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity question naire and the Australian sedentary behavior question naire . User acceptability of and satisfaction with the applications was explored via a post-intervention user survey . The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period . Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology . Preliminary data exploring sustained use of the applications across a longer time period yielded promising results . The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors OBJECTIVES To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan . DESIGN R and omized experimental design . SETTING A 3,800-bed medical center in northern Taiwan . PARTICIPANTS Elderly patients with hip fracture ( N=137 ) were r and omly assigned to an experimental ( n=68 ) or control ( n=69 ) group . INTERVENTION An interdisciplinary program of geriatric consultation , continuous rehabilitation , and discharge planning . MEASUREMENTS Demographic and outcome variables were measured . Outcome variables included service utilization , clinical outcomes , self-care abilities , health-related quality -of-life ( HRQOL ) outcomes , and depressive symptoms . RESULTS Subjects in the experimental group improved significantly more than those in the control group in the following outcomes : ratio of hip flexion 1 month after discharge ( P=.02 ) , recovery of previous walking ability at 1 month ( P=.04 ) and 3 months ( P=.001 ) after discharge , and activities of daily living at 1 month ( P=.01 ) and 2 months ( P=.001 ) after discharge . Three months after discharge , the experimental group showed significant improvement in peak force of the fractured limb 's quadriceps ( P=.04 ) and the following health outcomes : bodily pain ( P=.03 ) , vitality ( P<.001 ) , mental health ( P=.02 ) , physical function ( P<.001 ) , and role physical ( P=.006 ) . They also had fewer depressive symptoms ( P=.008 ) 3 months after discharge . CONCLUSION This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes , self-care abilities , and HRQOL and by decreasing depressive symptoms within 3 months after discharge OBJECTIVES To explore the 2-year outcomes of an interdisciplinary intervention for elderly patients with hip fracture . DESIGN R and omized experimental design . SETTING A 3,000-bed medical center in northern Taiwan . PARTICIPANTS Patients with hip fracture ( N=162 ) : 80 in the intervention group and 82 in the usual care control group .  INTERVENTION An interdisciplinary program of geriatric consultation , continuous rehabilitation , and discharge planning . MEASUREMENTS Outcomes ( clinical outcomes , self-care ability , health-related quality of life ( HRQoL ) , service utilization , and depressive symptoms ) were assessed 1 , 3 , 6 , 12 , 18 , and 24 months after discharge . Self-care ability ( ability to perform activities of daily living ( ADLs ) ) was measured using the Chinese Barthel Index . HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey , Taiwan version ( SF-36 ) . Depressive symptoms were measured using the Chinese Geriatric Depression Scale , short form . RESULTS Subjects in the intervention group had significantly better ratios of hip flexion ( beta=5.43 , P<.001 ) , better performance on ADLs ( beta=9.22 , P<.001 ) , better recovery of walking ability ( odds ratio (OR)=2.23 , P<.001 ) , fewer falls ( OR=0.56 , P=.03 ) , fewer depressive symptoms ( beta=-1.31 , P=.005 ) , and better SF-36 physical summary scores ( beta=6.08 , P<.001 ) than the control group during the first 24 months after discharge . The intervention did not affect the peak force of the fractured limb 's quadriceps , mortality , service utilization , or SF-36 mental summary score . CONCLUSION The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes , self-care ability , and physical health-related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge The authors prospect ively studied the effect of leisure-time physical activity level on  hip fracture risk  along with the influence of within-subject changes in activity levels , while taking possible confounding by other health behaviors and poor health into account . Analyses were based on pooled data from three population studies conducted in Copenhagen , Denmark . Among 13,183 women and 17,045 men , 1,121 first hip fractures were identified during follow-up . In comparison with being sedentary , the relative risk ( RR ) of hip fracture associated with being moderately physically active 2 - 4 hours per week was 0.72 ( 95 % confidence interval ( CI ) : 0.59 , 0.89 ) in women and 0.75 ( 95 % CI : 0.55 , 1.03 ) in men after adjustment for confounders . Being in the most active leisure activity category did not decrease the risk of hip fracture further . Adjustment for poor health affected the risk estimates only modestly . Subjects who , during follow-up , reduced their physical activity level from the highest or the intermediate activity level to a sedentary level had a higher risk of hip fracture than did those who remained moderately physically active at the intermediate level ( multivariate adjusted RR = 2.19 , 95 % CI : 1.00 , 4.84 and RR = 1.89 , 95 % CI : 1.21 , 2.95 , for reduction from the highest and intermediate levels , respectively ) . There was no evidence of a fracture-protective effect from increasing physical activity . In conclusion , moderate levels of physical activity appear to provide protection against later hip fracture . Decline in the physical activity level over time is an important risk factor for hip fracture PURPOSE To assess the effects of an interdisciplinary intervention on the trajectories of functional recovery among older patients with hip fracture during 2 years after hospitalization . DESIGN AND METHODS In a r and omized controlled trial with 24-month follow-up , 162 patients > 60 years were enrolled after hip-fracture surgery at a 3,000-bed medical center in northern Taiwan . Patients received an interdisciplinary program of geriatric consultation , in-hospital and at-home rehabilitation , and discharge planning ( n = 80 ) or usual care ( n = 82 ) . Patients ' functional status was assessed by the Chinese Barthel Index before discharge and at 1 , 3 , 6 , 12 , 18 , and 24 months after discharge . Covariates included demographic attributes , depressive symptoms , and cognitive functioning . Latent class growth modeling was used to examine distinctive groups of individual trajectories within the sample . RESULTS Functional recovery followed 3 distinct paths , approximated by either a quadratic or cubic function over time . These paths were ( a ) poor recovery ( 6.8 % ) , ( b ) moderate recovery ( 47.5 % ) , and ( c ) excellent recovery ( 45.7 % ) . The interdisciplinary intervention significantly reduced the likelihood of poor recovery ( relative risk ratio [ RRR ] = 0.05 , p < .01 ) and moderate recovery ( RRR = 0.17 , p < .01 ) , relative to excellent recovery . In addition , the major risk factors for poor or moderate recovery were older age , lower prefracture physical functioning , as well as higher depression scores and lower cognitive functioning before discharge . IMPLICATION S Distinct trajectories of functional recovery can serve as useful outcome measures in clinical research and practice OBJECTIVES To compare outcomes ( physical functions and discharge destinations ) of cognitively impaired and intact older hip fracture patients , and to identify cognitive skills related to functional gains . DESIGN Prospect i ve longitudinal study of hip fracture patients treated on an acute inpatient rehabilitation service , with evaluation of functional performance and living status determined at admission and discharge . SETTING A specialized inpatient geriatric rehabilitation program at Wesley Woods Geriatric Hospital , which is affiliated with Emory University School of Medicine . SUBJECTS Fifty-eight hip fracture patients , 35 with and 23 without cognitive impairment . MEASUREMENTS Cognitive functioning measured by the Mattis Dementia Rating Scale ( MDRS ) ; functional outcome assessed by the Functional Independence Measure ( FIM ) ; comparison of pre-fracture with discharge living environments . MAIN RESULTS Both cognitively impaired and intact hip fracture patients exhibited similar overall FIM motor improvements as well as functional gains in specific FIM areas measuring self-care , sphincter control , and locomotion ( e.g. , walking ) . Cognitively intact patients , however , displayed significantly greater gains in mobility ( e.g. , transfers ) at discharge . Cognitively impaired patients who lived in the community were as likely as intact patients to return to the community . Patients who entered the program at a modified dependence level ( FIM 3 - 5 ) and achieved motor independence  at discharge ( FIM 6 - 7 ) had higher MDRS initiation/ perseveration and memory scores . CONCLUSIONS Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination . Intensive post-fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement . Future research should examine the long-term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome OBJECTIVES To examine the influence of regular participation in chair exercises on postoperative deconditioning in respect of selected physiological , psychological and anthropometric variables . DESIGN Quasi-experimental , non-r and omised control group pre-test/post-test design where test group ( N = 20 ) and control group ( N = 10 ) were not equivalent because r and om selection and assignment were not possible . SUBJECTS Patients discharged from an orthopaedic ward 8 - 10 days after hip surgery who were cognitively competent ( mean score on Mini-Mental State Examination 26 ( SD 3.5 ) ) , sedentary ( mean score on Habitual Physical Activity Question naire for the Elderly 7.4 ( SD 3.3 ) ) women aged 70 years and above ( mean 80 ( SD 6.6 ) years ) . SETTING Hip fracture patients admitted to a multidisciplinary geriatric hospital for further medical observation . MEASUREMENTS Abstract ion of medical records provided information about co-morbidities and question naires assessed demographic , affective and cognitive function . Physiological , psychological and anthropometric status was measured pre- and post-intervention . RESULTS Data revealed high variability , suggesting that the effect of the independent variable was obscured by the heterogeneity of the cohort . Both groups improved similarly in grip strength , and in levels of depression and confidence . Body composition data explained the weight maintenance as a consequence of significant gains in fat-free mass in the experimental group . The significant change in systolic blood pressure and heart rate over the exercise and recovery period suggested that the 6-week period of moderate-intensity exercise was adequate to stimulate cardiovascular adaptations . CONCLUSIONS Whether or not the submaximal chair exercise regimen was of optimal benefit remains unclear . However , the intervention did appear to have contributed to the maintenance of the physical condition of older women temporarily disabled as a result of a fracture and subsequent hip surgery Objective : To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity ( MVPA ) in older adults . Method : Inactive older adults ( N = 38 , 68 ± 7 years old , 71 % female ) were r and omized to 12-week interventions targeting decreased sedentary behavior ( Sit Less ) or increased MVPA ( Get Active ) . The SenseWear armb and was used to objective ly assess activity in real time . Assessment s included a blinded armb and , the Community Health Activites Model Program for Senior ( CHAMPS ) question naire , 400-meter walk , and the Short Physical Performance Battery ( SPPB ) . Results : Objective ly measured MVPA increased in Get Active ( 75 ± 22 min/week , p < .001 ) ; self-reported MVPA increased in both groups ( p < .05 ) . Sedentary behavior did not change in either group ( all p > .05 ) . Only the Sit Less group improved the SPPB score ( 0.5 ± 0.3 , p = .046 ) . Discussion : Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks . Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed Although much research has documented the functional outcomes in hip repair surgery , few studies have identified effective interventions to improve functional outcomes . The purpose of this study was to test the use of generic and individualized videos on patients ' return to preoperative levels of independent functioning , increased physical performance , improved coping ability , and enhanced perception of ability to care for self .  Two rehabilitation units in separate acute care facilities were used to recruit subjects . Data were collected on 82 participants on admission to the study , on discharge from rehabilitation , 1 week after discharge , and 3 months post discharge . The results indicate that video intervention has some benefit to persons recovering from hip repair surgery . The benefits were realized in physical performance as evidence d by a significant difference in the distance walked and time walked of participants in the treatment group OBJECTIVES The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status . Accordingly , this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge . DESIGN A secondary analysis of data from a r and omized controlled trial with 24-month follow-up . SETTING A 3000-bed medical center in northern Taiwan . PARTICIPANTS Subjects were included only if they had " poor nutritional status " at hospital discharge , including those at risk for malnutrition or malnourished . The sub sample included 80 subjects with poor nutritional status in the comprehensive care group , 87 in the interdisciplinary care group , and 85 in the usual care group .  INTERVENTIONS The 3 care models were usual care , interdisciplinary care , and comprehensive care . Usual care provided no in-home care , interdisciplinary care provided 4 months of in-home rehabilitation , and comprehensive care included management of depressive symptoms , falls , and nutrition as well as 1 year of in-home rehabilitation . MEASUREMENTS Data were collected on nutritional status and physical functions , including range of motion , muscle power , proprioception , balance and functional independence , and analyzed using a generalized estimating equation approach . We also compared patients ' baseline characteristics : demographic characteristics , type of surgery , comorbidities , length of hospital stay , cognitive function , and depression . RESULTS Patients with poor nutritional status who received comprehensive care were 1.67 times ( 95 % confidence interval 1.06 - 2.61 ) more likely to recover their nutritional status than those who received interdisciplinary and usual care . Furthermore , the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge , but not of those who had not yet recovered . CONCLUSIONS An in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition . This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status OBJECTIVES To identify care setting s associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period . DESIGN Prospect i ve cohort study . SETTING Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged . PARTICIPANTS Hip fracture patients aged 65 and older who underwent surgery for hip fracture .  MEASUREMENTS A  full-body skin examination  was conducted at baseline ( as soon as possible after hospital admission ) and repeated on alternating days for 21 days . Patients were deemed to have an acquired pressure ulcer ( APU ) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission . RESULTS In 658 study participants , the APU cumulative incidence at 32 days after initial hospital admission was 36.1 % ( st and ard error 2.5 % ) . The adjusted APU incidence rate was highest during the initial acute hospital stay ( relative risk (RR)=2.2 , 95 % confidence interval (CI)=1.3 - 3.7 ) and during re-admission to the acute hospital ( RR=2.2 , 95 % CI=1.1 - 4.2 ) . The relative risks in rehabilitation and nursing home setting s were 1.4 ( 95 % CI=0.8 - 2.3 ) and 1.3 ( 95 % CI=0.8 - 2.1 ) , respectively . CONCLUSION Approximately one-third of hip fracture patients developed an APU during the study period . The rate was highest in the acute setting , a finding that is significant in light of Medicare 's policy of not reimbursing hospitals for the treatment of hospital-APUs . Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals Objective To test whether a long term , structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations . Design Multicenter , single blinded r and omized trial ( Lifestyle Interventions and Independence for Elders ( LIFE ) study ) . Setting Eight centers across the United States , February 2010 to December 2011 . Participants 1635 sedentary adults aged 70 - 89 years with functional limitations , defined as a short physical performance battery score ≤9 , but who were able to walk 400 m. Interventions A permuted block algorithm stratified by field center and sex was used to allocate interventions . Participants were r and omized to a structured , moderate intensity physical activity program ( n=818 ) conducted in a center ( twice a week ) and at home ( 3 - 4 times a week ) that included aerobic , strength , flexibility , and balance training activities , or to a health education program ( n=817 ) consisting of workshops on topics relevant to older people and upper extremity stretching exercises . Main outcome measures Serious fall injuries , defined as a fall that result ed in a clinical , non-vertebral fracture or that led to a hospital admission for another serious injury , was a prespecified secondary outcome in the LIFE Study . Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment . All participants were included in the analysis . Results Over a median follow-up of 2.6 years , a serious fall injury was experienced by 75 ( 9.2 % ) participants in the physical activity group and 84 ( 10.3 % ) in the health education group ( hazard ratio 0.90 , 95 % confidence interval 0.66 to 1.23 ; P=0.52 ) . These results were consistent across several subgroups , including sex . However , in analyses that were not prespecified , sex specific differences were observed for rates of all serious fall injuries ( rate ratio 0.54 , 95 % confidence interval 0.31 to 0.95 in men ; 1.07 , 0.75 to 1.53 in women ; P=0.043 for interaction ) , fall related fractures ( 0.47 , 0.25 to 0.86 in men ; 1.12 , 0.77 to 1.64 in women ; P=0.017 for interaction ) , and fall related hospital admissions ( 0.41 , 0.19 to 0.89 in men ; 1.10 , 0.65 to 1.88 in women ; P=0.039 for interaction ) . Conclusions In this trial , which was underpowered to detect small , but possibly important reductions in serious fall injuries , a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations . These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men . Trial registration Clinical sTrials.gov NCT01072500 Objective : To investigate if motivational interviewing improved physical activity , self-efficacy , quality of life , mobility and mental health in people living in the community after hip fracture . Design : Single-blind r and omized controlled trial . Setting : Community . Participants : A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14 ) or an intervention group ( n = 16 ) . Intervention : All participants received usual care . The intervention group also received eight weekly sessions of motivational interviewing as additional input , with the control group having no additional matching input . Main outcomes : The primary outcome was physical activity levels as measured by an accelerometer ( steps taken per day , time spent walking per day , and time spent sitting or lying each day ) . Secondary outcomes included self-efficacy ( confidence about walking and not falling ) , health-related quality of life , mobility and mental health . Results : Relative to usual care , the motivational interviewing group took significantly more steps per day ( mean = 1237 steps , 95 % confidence interval ( CI ) 12 to 2463 ) , walked for longer per day ( mean = 14.4 minutes , 95 % CI 0.6 to 28.8 ) , had improved self-efficacy evidence d by being more confident about walking ( mean = 1.6 units out of 10 , 95 % CI 0.3 to 2.9 ) and not falling ( mean = 1.1 units out of 10 , 95 % CI 0.3 to 1.9 ) and improved health-related quality of life and mental health . Conclusion : This study provides preliminary evidence that motivational interviewing can result in clinical ly meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture BACKGROUND Proximal femoral fracture is a major health problem in old age , with annual UK health and social care costs of £ 2.3B . Rehabilitation has the potential to maximise functional recovery and maintain independent living , but evidence of clinical effectiveness and cost-effectiveness is lacking . OBJECTIVES To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive r and omised controlled trial ( RCT ) and economic evaluation . DESIGN Phase I - realist review , survey and focus groups to develop the rehabilitation package . Phase II - parallel-group , r and omised ( using a dynamic adaptive algorithm ) feasibility study with focus groups and an anonymised cohort study . SETTING Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board , North Wales . The intervention was delivered in the community following hospital discharge . PARTICIPANTS Older adults ( aged ≥ 65 years ) who had received surgical treatment for hip fracture , lived independently prior to fracture , had mental capacity ( assessed by the clinical team ) and received rehabilitation in the North Wales area . INTERVENTIONS Participants received usual care ( control ) or usual care plus an enhanced rehabilitation package ( intervention ) . Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital , community hospital and community services depending on need and availability . The intervention was design ed to enhance rehabilitation by improving patients ' self-efficacy and increasing the amount and quality of patients ' practice of physical exercise and activities of daily living . It consisted of a patient-held information workbook , a goal - setting diary and six additional therapy sessions . MAIN OUTCOME MEASURES The primary outcome measure was the Barthel Activities of Daily Living ( BADL ) index . The secondary outcome measures included the Nottingham Extended Activities of Daily Living ( NEADL ) scale , EuroQol-5 Dimensions , ICEpop CAPability measure for Older people , General Self-Efficacy Scale , Falls Efficacy Scale - International ( FES-I ) , Self-Efficacy for Exercise scale , Hospital Anxiety and Depression Scale ( HADS ) and service use measures . Outcome measures were assessed at baseline and at 3-month follow-up by blinded research ers . RESULTS Sixty-two participants were recruited ( 23 % of those who were eligible ) , 61 were r and omised ( control , n = 32 ; intervention , n = 29 ) and 49 ( 79 % ) were followed up at 3 months . Compared with the cohort study , a younger , healthier sub population was recruited . There were minimal differences in most outcomes between the two groups , including the BADL index , with an adjusted mean difference of 0.5 ( Cohen 's d = 0.29 ) . The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group , with an adjusted mean difference between groups of 3.0 ( Cohen 's d = 0.63 ) . There was a trend for greater improvement in FES-I and HADS in the intervention group , but with small effect sizes , with an adjusted mean difference of 4.2 ( Cohen 's d = 0.31 ) and 1.3 ( Cohen 's d = 0.20 ) , respectively . The cost of delivering the intervention was £ 231 per patient . There was a possible small relative increase in quality -adjusted life-years in the intervention group . No serious adverse events relating to the intervention were reported . CONCLUSIONS Trial methods were feasible in terms of eligibility , recruitment and retention , although recruitment was challenging . The NEADL scale was more responsive than the BADL index , suggesting that the intervention could enable participants to regain better levels of independence compared with usual care . This should be tested in a definitive Phase III RCT . There were two main limitations of the study : the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure . TRIAL REGISTRATION Current Controlled Trials IS RCT N22464643 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 44 . See the NIHR Journals Library for further project information Adults are sedentary for an alarming 9 to 10 hours per day ( 1 ) . Accordingly , the popular press has coined the phrase sitting is the new smoking to describe a current epidemic of developed nations ( 24 ) . Evidence indicates that sedentary time is associated with incident cardiovascular disease , incidence of cardiovascular diseaserelated risk factors , and mortality ( 5 , 6 ) . Of note , the risk conferred by prolonged sedentariness is eliminated only by high levels of moderate- to vigorous-intensity physical activity ( MVPA ) ( about 60 to 75 min/d ) , which exceed physical activity recommendations ( 7 , 8) . As such , sedentary behavior is now believed to represent a clinical ly important aspect of a person 's physical activity profile and is no longer considered simply the extreme low end of the physical activity continuum ( 5 ) . Studies linking sedentary behavior to health outcomes have relied almost exclusively on self-reported  sedentary time  , which is subject to reporting bias and measurement error ( 9 ) . A 2015 systematic review ( 5 ) identified only 1 study ( NHANES [ National Health and Nutrition Examination Survey ] ) that examined the association between objective ly measured sedentary time and health outcomes , a study limited by a small event rate ( 10 ) . New studies using NHANES data have since been published , with longer follow-up and higher event rates ( 1115 ) . However , some of these studies have reported an association between objective ly measured sedentary time and mortality ( 11 , 14 , 15 ) , but others have not ( 12 , 13 ) . Additional cohort studies are thus needed to rectify evidence gaps . Furthermore , studies using accelerometers to objective ly measure sedentary behavior conventionally operationalize sedentary time as the total number of sedentary minutes per day . This approach ignores patterns of accumulated sedentary behavior over time . For example , accumulation of sedentary time in a few long bouts or many short bouts represents 2 distinct patterns of sedentary time accrual . Experimental studies have shown that acute periods of prolonged , uninterrupted sedentary behavior cause greater detrimental cardiometabolic effects than sedentary behavior that is periodically interrupted ( 1618 ) , suggestive that it is not just total sedentary time that is relevant to health outcomes , but also the manner in which it is accumulated . Few longitudinal studies , however , have explored the association between prolonged , uninterrupted sedentary behavior and mortality to corroborate these findings . To inform guidelines on reducing sedentary behavior ( target reductions in overall sedentary time or target interruption of prolonged sedentary bouts ) , evidence from prospect i ve studies is needed to 1 ) confirm the association between total sedentary time and mortality using objective measures , 2 ) determine whether prolonged sedentary bouts confer risk for death , and 3 ) eluci date whether the total volume of sedentary time and its pattern of accumulation individually or jointly contribute to risk for death . The purpose of this study , therefore , was to examine the association between objective ly measured sedentary time ( both total volume and accrual in prolonged bouts ) and all-cause mortality in a national cohort of U.S. middle-aged and older adults enrolled in the REGARDS ( Reasons for Geographic and Racial Differences in Stroke ) study . Methods Study Population REGARDS is a population -based study design ed to examine racial and regional disparities in stroke . It comprises 30239 white and black adults aged 45 years or older enrolled between 2003 and 2007 from across the contiguous United States ( 19 , 20 ) . Detailed design and methods for REGARDS are described elsewhere ( 21 ) . Briefly , demographic and cardiovascular risk factor data were collected by telephone interview and an in-home physical assessment on enrollment . A detailed summary of baseline measures is provided in the Supplement . Participants ( or their proxies ) were then followed for 6-month intervals to ascertain vital status . Objective measurements of sedentary behavior were collected from active REGARDS participants from 2009 to 2013 ( mean time from study enrollment , 5.7 years [ SD , 1.5 ] ; range , 1.9 to 9.5 years ) ( 22 ) . A total of 7985 participants adhered to accelerometer wear requirements ( 4 days with accelerometer wear 10 hours ) , provided follow-up data , and were available for the current analyses ( Supplement Figure 1 ) . Supplement Table 1 shows the characteristics of included versus excluded REGARDS participants . The REGARDS study protocol was approved by the institutional review boards of participating institutions . All participants provided informed consent . Supplement . Supplementary Material Accelerometer Data Collection Methods for accelerometer data collection are described elsewhere ( 22 ) . Briefly , participants were fitted with an Actical ( Philips Respironics ) accelerometer secured to their right hip using a nylon belt and were instructed to wear the device during waking hours for 7 consecutive days . The Actical had been vali date d formeasurement of physical activity and sedentary behavior and was shown to have acceptable reliability ( 2325 ) . Activity counts were summed over 1-minute epochs . Nonwear periods were defined as at least 150 consecutive minutes of 0 activity counts . This nonwear algorithm was previously vali date d against daily log sheets in REGARDS participants ( 26 ) . Measurements of 0 to 49 , 50 to 1064 , and at least 1065 counts per minute were defined as sedentary behavior , light-intensity physical activity , and MVPA , respectively , as determined in a laboratory-based calibration study ( 27 ) . A sedentary bout was defined as consecutive minutes in which the accelerometer registered fewer than 50 counts per minute . A sedentary break was defined as at least 1 minute in which 50 or more counts per minute were registered after a sedentary bout . Both sedentary bouts and breaks were exclusively continuous periods , with no interruptions or nonwear intervals allowed in the definition . Outcome Ascertainment All-cause mortality was the primary outcome , defined as any death after completion of the accelerometer protocol regardless of cause . Date s of death were confirmed through review of death certificates , medical records , and administrative data bases . Deaths through 4 September 2015 were included in the current analysis . Statistical Analysis Sedentary and physical activity variables were averaged across compliant days ( 10 hours of wear ) . Because of a high correlation between total sedentary time and wear time ( Supplement Figure 2 ) , we corrected for the influence of wear time by st and ardizing total sedentary time to 16 hours of wear time per day using the residuals obtained when regressing total sedentary time on wear time ( see Methods section of the Supplement ) ( 2830 ) . Participants were stratified into quartiles according to total sedentary time and , separately , mean sedentary bout duration ( a measure of overall prolonged , uninterrupted sedentary behavior ) . Cox proportional hazards regression modeling was used to calculate the hazard ratio ( HR ) for all-cause mortality associated with quartiles of total sedentary time ( and separately , mean sedentary bout length ) . Crude HRs were initially calculated . Subsequent HRs were calculated after adjustment for age , race , sex , region of residence , education , and season the accelerometer was worn ( model 1 ) , with further adjustment for current smoking , alcohol use , body mass index ( BMI ) , diabetes , hypertension , dyslipidemia , estimated glomerular filtration rate less than 60 mL/min/1.73 m2 , atrial fibrillation , history of coronary heart disease , and history of stroke ( model 2 ) . Models were additionally adjusted for MVPA expressed continuously ( model 3 ) . Tests for linear trend across quartiles were conducted by including the quartile for each participant as an ordinal variable in regression models . Proportional hazards assumptions were confirmed with a Kolmogorov-type supremum test ( 31 ) . The above analyses were then repeated in a fully adjusted model , testing interactions for age ( < 65 and 65 years ) , sex ( male and female ) , race ( black and white ) , BMI category ( normal weight and overweight or obese ) , and MVPA category ( < 150 min/wk and 150 min/wk ) . As a secondary analysis , we examined the continuous doseresponse relationship between each sedentary characteristic and all-cause mortality in a fully adjusted model ( model 3 ) using restricted cubic splines ( 32 ) . Cubic polynomials were fitted with the mean of each sedentary characteristic set as the reference and knots placed at the 5th , 35th , 65th , and 95th percentiles ( 33 ) . Nonlinear associations were evaluated using the likelihood ratio test . For nonlinear associations , spline models were used to describe the associations and when the association was determined to be linear , a linear model was used . Because of multicollinearity between total sedentary time and mean sedentary bout duration ( r= 0.61 ) , both variables were not included in the same model . Alternatively , to examine the individual and joint associations of total sedentary time and prolonged , uninterrupted sedentary behavior with mortality , participants were classified into 4 categories : low total sedentary time ( < 750 min/d ) and low prolonged sedentary bout time ( < 10 min/bout ) , low total sedentary time  and high prolonged sedentary bout time  ( 10 min/bout ) , high total sedentary time  ( 750 min/d ) and low prolonged sedentary bout time , and high total sedentary time and high prolonged sedentary bout time . Hazard ratios for all-cause mortality were calculated for each joint category in comparison with the lowlow group in a fully adjusted model ( model 3 ) . Thresholds for total sedentary time ( 750 min/d ) and mean sedentary bout duration ( 10 min/bout ) were selected on the basis of the restricted cubic splines and were confirmed using a method described by Contal and O'Quigley ( see Methods section of the Supplement ) ( 34 ) . To allow for the possibility that sedentary bouts BACKGROUND Elderly patients with hip fracture have been found to benefit from subacute care interventions that usually comprise usual care with added geriatric intervention , early rehabilitation , and supported discharge . However , no studies were found on the effects of combining subacute care and health-maintenance interventions on health outcomes for elders with hip fracture . OBJECTIVES To compare the effects of an interdisciplinary comprehensive care programme with those of subacute care and usual care programmes on health-related quality of life ( HRQoL ) for elderly patients with hip fracture . DESIGN R and omised controlled trial . SETTING S A 3000-bed medical centre in northern Taiwan . PARTICIPANTS Patients with hip fracture ( N=299 ) were r and omised into three groups : subacute care ( n=101 ) , comprehensive care ( n=99 ) , and usual care ( n=99 ) . METHODS Subacute care included geriatric consultation , continuous rehabilitation , and discharge planning . Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms , manage malnutrition , and prevent falls . Usual care included only 1 - 2 in-hospital rehabilitation sessions , discharge planning without environmental assessment , no geriatric consultation , and no in-home rehabilitation .  HRQoL was measured using the Medical Outcomes Study Short-Form 36 Taiwan version at 1 , 3 , 6 , and 12 months after discharge . RESULTS Participants in the comprehensive care group improved more in physical function , role physical , general health and mental health than those in the usual care group . The subacute care group had greater improvement in physical function , role physical , vitality , and social function than the usual care group . The intervention effects for both comprehensive and subacute care increased over time , specifically from 6 months after hip fracture onward , and reached a maximum at 12 months following discharge . CONCLUSIONS Both comprehensive care and subacute care programmes may improve health outcomes of elders with hip fracture . Our results may provide a reference for health care providers in countries using similar programmes with Chinese/Taiwanese immigrant population
Conclusion : Based on available evidence , older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery
Objective : To synthesize evidence on older adults ’  sedentary behavior and physical activity during rehabilitation and recovery for hip fracture ( 1 ) across the care continuum and ( 2 ) from clinical interventions .