Multicomponent Home-based Physical Therapy Versus Usual Care for Recovery After Hip Fracture.
Nikhil K Prasad, Rashmita Bajracharya, Marniker Wijesinha and 7 others
PMID 37610404WHAT IT FOUND
Home-based physical therapy after usual care improved walking speed and physical performance scores more than usual care alone.
Both the specific exercise group and the active control group showed similar gains, suggesting that additional therapy sessions themselves may drive recovery.
Key findings
01Participants in both home-based physical therapy groups had significantly greater improvements in Short Physical Performance Battery scores and gait speed from 75 days to 1 year compared to the usual care group.
02The active control group, which received seated range of motion exercises and TENS, improved to a similar extent as the group receiving specific strength and balance training.
03Sensitivity analyses confirmed that both physical therapy intervention groups showed greater functional restoration than the usual care cohort.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The comparison is between two different studies conducted in different time periods (2006-2010 vs 2014-2017), which introduces potential bias from changes in standard of care. Participants in the intervention groups consented to a rigorous 16-week home program, suggesting they may have been more motivated or capable than the usual care cohort, who only consented to study visits. The usual care group had worse baseline function and was assessed earlier in the recovery timeline, which complicates direct comparison of change over time. The study could not identify which specific component of the multi-component interventions (e.g., number of visits, intensity, therapist interaction) caused the observed improvements. More than 90% of participants were white, limiting generalizability to the broader US population. Missing data occurred in all groups, though statistical models attempted to account for this.
Declared interests
Jay Magaziner serves on advisory boards for the American Orthopedics Association Own the Bone Multi-Disciplinary Advisory Board and Fragility Fracture Network Board of Directors, and has consulted with Pluristem. Kathleen Mangione consults with Pluristem. Other authors declared no relevant conflicts.
The easy way to misread this
Do not interpret the similar outcomes of the PUSH and PULSE groups as evidence that specific strength and balance training is unnecessary. The active control (PULSE) was a highly structured, progressive program delivered by licensed therapists, not passive care. The gains may reflect the benefit of any sustained, supervised physical activity or therapist contact rather than the specific exercise type.