美国马里兰大学、阿卡迪亚大学等机构研究人员在最新研究中，分析了多元居家物理治疗干预对老年人髋部骨折后步行能力的影响。 2019年9月10日出版的《美国医学会杂志》发表了这项成果。

2013年9月16日至2017年6月20日，美国的3个临床中心招募了210名参与者，平均年龄为80.8岁，76.7%为女性，均为非病理性微创性髋部骨折。随机分为两组，其中干预组105例，进行主动治疗，包括有氧、力量、平衡和功能训练；对照组105例，接受经皮神经电刺激和活动范围锻炼，两组患者均同时进行基础护理。

最终有197名患者（93.8%）完成了试验，干预组96名，对照组101名。16周时，干预组中有22名（22.9％）患者可在6分钟内行走300米及以上，对照组中有18名（17.8％），差异不显著。在此过程中，干预组中有17名（16.2%）患者发生一起或多起不良事件，对照组有15名（14.3%）。最常见的不良事件报道是跌倒（干预组6例，对照组4例），股骨/髋部骨折（每组2例），肺炎（干预组2例），尿路感染（干预组2例），脱水（对照组2例），和呼吸困难（对照组2例）。

综上，对髋部骨折的老年人进行多元居家物理治疗干预，与包括经皮神经电刺激和活动范围锻炼的主动对照相比，并没有显著提高16周时的步行能力。

附：英文原文

Title: Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial

Author: Jay Magaziner, Kathleen K. Mangione, Denise Orwig, Mona Baumgarten, Laurence Magder, Michael Terrin, Richard H. Fortinsky, Ann L. Gruber-Baldini, Brock A. Beamer, Anna N. A. Tosteson, Anne M. Kenny, Michelle Shardell, Ellen F. Binder, Kenneth Koval, Barbara Resnick, Ram Miller, Sandra Forman, Ruth McBride, Rebecca L. Craik

Issue&Volume: Vol 322 No 10

Abstract: 

Importance  Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community.

Objective  To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community.

Design, Setting, and Participants  Parallel, 2-group randomized clinical trial conducted at 3 US clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hip fracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily activities at the time of enrollment. A total of 210 participants were randomized and reassessed 16 and 40 weeks later.

Interventions  The training intervention (active treatment) (n = 105) included aerobic, strength, balance, and functional training. The active control group (n = 105) received transcutaneous electrical nerve stimulation and active range-of-motion exercises. Both groups received 2 to 3 home visits from a physical therapist weekly for 16 weeks; nutritional counseling; and daily vitamin D (2000 IU), calcium (600 mg), and multivitamins.

Main Outcomes and Measures  The primary outcome (community ambulation) was defined as walking 300 m or more in 6 minutes at 16 weeks after randomization. The study was designed to test a 1-sided hypothesis of superiority of training compared with active control.

Results  Among 210 randomized participants (mean age, 80.8 years; 161 women [76.7%]), 197 (93.8%) completed the trial (187 [89.0%] by completing the 6-minute walk test at 16 weeks and 10 [4.8%] by adjudication of the primary outcome). Among these, 22 of 96 training participants (22.9%) and 18 of 101 active control participants (17.8%) (difference, 5.1% [1-sided 97.5% CI, −∞ to 16.3%]; 1-sided P = .19) became community ambulators. Seventeen training participants (16.2%) and 15 control participants (14.3%) had 1 or more reportable adverse events during the intervention period. The most common reportable adverse events reported were falls (training: 6 [5.7%], control: 4 [3.8%]), femur/hip fracture (2 in each group), pneumonia (training: 2, control: 0), urinary tract infection (training: 2, control: 0), dehydration (training: 0, control: 2), and dyspnea (training: 0, control: 2).

Conclusions and Relevance  Among older adults with a hip fracture, a multicomponent home-based physical therapy intervention compared with an active control that included transcutaneous electrical nerve stimulation and active range-of-motion exercises did not result in a statistically significant improvement in the ability to walk 300 m or more in 6 minutes after 16 weeks.

DOI: 10.1001/jama.2019.12964

Source: https://jamanetwork.com/journals/jama/article-abstract/2749599