Enhancing Rehabilitation After Hip Fracture

Study Overview
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Brief Summary
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This study evaluates the feasibility of implementing a unilaterally biased high-intensity resistance training to facilitate restorative vs. compensatory recovery after usual care physical therapy among older adults who have recently incurred a hip fracture. Additionally, physical performance during a sit-to-stand task, muscle function (strength/power), physical function measures, muscle composition, and muscle quality (force/unit area), are assessed before and after targeted high-intensity resistance training.

Detailed Description
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Hip fracture is a major public health concern in the United States. Fall-related injuries constitute the leading cause of deaths and disabilities among persons over age 65 years. Hip fracture is consistently identified as one of the most frequent, costly, and devastating non-lethal injuries from a fall. Rehabilitation after hip fracture remains largely unchanged over the last 30 years despite evidence that high-intensity rehabilitation can benefit physical function after hip fracture beyond the recovery typical with usual care. Asymmetries demonstrated in physical performance of various tasks, such as gait, balance, and a sit-to-stand transfer, and impaired surgical limb muscle function are evident for years after hip fracture, and may contribute to the high rate of falls and declining function typically encountered by older adults recovering from hip fracture. Implementing a high-intensity rehabilitation approach targeting asymmetries after hip fracture is likely to yield improved symmetry in both physical function and muscle function. This study will recruit older adults who have recently incurred a hip fracture and completed usual care physical therapy to determine whether a high-intensity rehabilitation strategy targeting asymmetries in movement strategies and muscle function of the surgical limb can be successfully implemented in this challenging population. In particular, recruitment, adherence to rehab protocol parameters, and retention will be addressed among those who initiate high-resistance training at approximately 8-12wk after hip fracture incidence. In addition, the investigators will explore the potential of targeted unilaterally-biased resistance training to improve surgical limb function and performance after hip fracture. Specifically, physical performance, muscle function, and muscle quality/composition are recorded and compared pre-/post-training to determine whether improvements occur in conjunction with high-intensity rehabilitation training. Additionally, the investigators will measure improvements in muscle composition that occur as a result of this high-intensity resistance training.

Official Title
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Enhanced Rehabilitation Targeting Strength and Movement Pattern Symmetry Following Hip Fracture

Conditions
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Hip Fracture

Intervention / Treatment
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* Behavioral: Unilaterally Biased Resistance Training / MOVE


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age greater than 50 yrs Ability to sign informed consent Mental Status MoCA score greater than 22 Independent community ambulatory prior to hip fracture Ability to ambulate greater than 50 feet with or without assistive device Exclusion Criteria: Previous hip fracture Bilateral hip fracture Pathological fracture Expected life Expectancy less than one year Permanently institutionalized Fracture result of multi-trauma Cardiac abnormalities Neuromuscular impairments Unstable medical conditions Elevated systolic greater than 150 or diastolic blood pressure greater than 100 Implanted electronic devices History of stroke with motor disability Alcohol or drug abuse Respiratory disease Conditions deemed exclusionary by PI or physician

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental<br>High-Intensity, Unilaterally-Biased Resistance training 3x/wk x 12wk MOVE | Behavioral: Unilaterally Biased Resistance Training / MOVE<br>* High-intensity resistance training including: whole body movement patterns, unilaterally biased lower extremity strength training, task-oriented balance tasks<br>* Other names: High-Intensity Task Oriented Strength Training / HI-TOSS;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| muscle strength | Knee extension muscle strength was measured on an isokinetic dynamometer as a maximum voluntary isometric contraction in newtons (N) of force. The average of three trials was used. | 12 week | 
| muscle power | Leg extension muscle power was measured on a Nottingham power rig in watts (W). The average of three trials was used. | 12 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sit-to-stand task performance | biomechanics (vGRF) measured during sit-to-stand task performance | 12 week | 
| usual gait speed | Gait speed was measured at usual speed over a 50 foot distance and reported in meters/second. | 12 week | 
| muscle mass | MRI analysis of quadriceps muscle mass reported as average cross-sectional area in cm2. | 12 week | 
| Modified Physical Performance Test | The modified physical performance test (mPPT) is a standardized nine-item test designed to assess multiple dimensions of physical function was used to assess overall physical function. Scores are reported on a scale from 0-36. | 12 week | 
| Berg Balance Scale | The Berg Balance Scale (BBS) is a 14-item objective scale that provides a reliable and valid measure of static balance, with scores less than 45 indicating significant fall risk among older adults. Scores range from 0-56. | 12 week | 
| Timed up and Go Test | The Timed up and go test is recorded as the time in seconds to stand, walk 3 meters, turn around and return to a chair. The average time of three trials is reported. | 12 week | 
| Stair Climb Test | The time taken to ascend 10 stairs is reported. | 12 week | 
| Stair Descent Test | The time taken to descend 10 stairs is reported. | 12 week | 
| Lower Extremity Measure | The Lower Extremity Measure (LEM) is a 29-item self-report questionnaire that is reliable, valid, and responsive to improvement, with scores of 75 indicating moderate frailty, and scores above 85 indicating normal mobility and physical function after hip fracture. Scores range from 0-100. | 12 week | 
| Activities Specific Balance Scale | Activities-Specific Balance Confidence (ABC) scale is a 16-item, validated, reliable, self-report scale used to determine balance confidence. Scores range from 0-100. | 12 week | 
| Six minute walk test | The distance in meters (m) walked in six minutes is recorded. | 12 week. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hip fracture, physical function, muscle function, symmetry