Effects of home-based physical exercise on days at home, healthcare utilization and functional independence among patients with hip fractures: a randomized controlled trial

Arch Phys Med Rehabil. 2021 Apr 30;S0003-9993(21)00331-2. doi: 10.1016/j.apmr.2021.04.004. Online ahead of print.

Abstract

Objective: To 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.

Design: Randomized controlled trial with parallel two-group design, consisting of a 12-month intervention and 12-month registry follow-up.

Setting: Home-based intervention.

Participants: Patients with operated hip fracture, living at home, aged ≥60 years, randomized into physical-exercise (n=61) or usual-care (n=60) groups.

Intervention: Supervised physical exercise twice a week.

Main outcome measures: The 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.

Results: Over 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.

Conclusions: Long-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.

Keywords: Aged; Cost Analysis; Exercise; Functional Status; Health Services; Hip Fractures; Rehabilitation.