Effect of an additional health professional-led exercise programme on clinical health outcomes after hip fracture

Purpose: To examine the effect of an additional two-week health professional-led functional exercise programme compared to usual care for patients after hip fracture during a short-term nursing home stay directly after hospital discharge. Method: One hundred and forty participants, 65 years or older with hip fracture, admitted to a short-term nursing home stay were randomised to an intervention group or control group. Participants in the intervention group (n= 78) received the experimental programme consisted of functional exercises, performed by health care professionals up to four times a day, seven days a week, in addition to usual care during a two-week short-term nursing home stay. Participants in the control group (n= 62) received usual care alone. Primary outcome was Short Physical Performance Battery (SPPB). Secondary outcomes were Timed Up & Go (TUG), New Mobility Score (NMS), UCLA activity scale, Fall efficacy scale international (FES-I), The EuroQol five dimensionfive-level questionnaire (EQ-5D-5L), and numeric rating scale (NRS) for pain. Outcome measures were assessed after two weeks in a short-term nursing home stay and three months after hip fracture surgery. The activity monitor ActivPal registered activity during the two-week short-term nursing home stay.Results: No statistically significant differences between groups was found in any outcomes after two weeks or three months (p>0.05). There were statistically significant within-group improvements in primary outcome SPPB and in most secondary outcomes at all time points in both groups (p > 0.05). Conclusions: A two-week health professional-led functional exercise programme in addition to usual care demonstrated no difference in clinical outcomes compared to usual care alone up to three months after hip fracture. The patients with hip fracture are fragile and vulnerable in this early phase, and usual physiotherapy may be sufficient to improve their physical function. Trial registration: ClinicalTrials.gov NCT02780076

Functional improvements desired by patients before and in the first year after total hip arthroplasty

Background In the field of rehabilitation, patients are supposed to be experts on their own lives, but the patient’s own desires in this respect are often not reported. Our objectives were to describe the patients’ desires regarding functional improvements before and after total hip arthroplasty (THA). Methods Sixty-four patients, 34 women and 30 men, with a mean age of 65 years, were asked to describe in free text which physical functions they desired to improve. They were asked before surgery and at three and 12 months after surgery. Each response signified one desired improvement. The responses were coded according to the International Classification of Functioning, Disability and Health (ICF) to the 1st, 2nd and 3rd category levels. The frequency of the codes was calculated as a percentage of the total number of responses of all assessments times and in percentage of each time of assessment. Results A total of 333 responses were classified under Part 1 of the ICF, Functioning and Disability, and 88% of the responses fell into the Activities and Participation component. The numbers of responses classified into the Activities and Participation component were decreasing over time (p < 0.001). The categories of Walking (d450), Moving around (d455), and Recreation and leisure (d920) included more than half of the responses at all the assessment times. At three months after surgery, there was a trend that fewer responses were classified into the Recreation and leisure category, while more responses were classified into the category of Dressing (d540). Conclusions The number of functional improvements desired by the patients decreased during the first postoperative year, while the content of the desires before and one year after THA were rather consistent over time and mainly concerned with the ability to walk and participate in recreation and leisure activities. At three months, however, there was a tendency that the patients were more concerned about the immediate problems with putting on socks and shoes

Fysioterapibehandlingens kompleksistet med fokus på kropp og kjønn - en videoanalyse av et eksempel fra praksis

This article is based on the Master thesis «Diving into practice. A qualitative analysis of certain aspects in physiotherapy treatment». The basis for this discussion is that the relationship of the physiotherapist and the patient will be a crucial part of the treatment. In this material they are both women. The analysis shows from the very beginning of the treatment that both women communicate in a very limited and inhabited way. The bodily experience of the patient is given little attention from the physiotherapist. By her way of communicating the physiotherapist turns the patient´s body into an object that she has an intention to alter. The therapist changes her roles between being determined and jovial throughout the treatment. Through a perspective of social gender this article focuses upon the experiences of femininity and womanhood, how these experiences are communicated through joviality. This knowledge gives new perspectives and meaning to the context of treatment. By making the treatment interaction more transparent and open knowledge is developed on how body and gender are involved and expressed in physiotherapy practic