The effect of a multifactorial rehabilitation program in functional outcomes and prevention of falls after a hip fracture, in older subjects.

Abstract

Introduction: Falls in people over 65 years of age lead to a progressive increase in hip fractures, with their management becoming a global challenge for both patients and National Health Systems.

Aim: The purpose of the study was to investigate the effect of a multifactorial rehabilitation program on improving functional activity and reducing secondary falls in elderly people after hip fracture surgery.

Material & Method: A prospective, randomized, unblinded, controlled, parallel group study was performed. The research population consisted of people over 65 years of age (n=32) who have been hospitalized at the Orthopedic Clinic of the "Venizelio" Hospital of Heraklion, Crete, due to an operated hip fracture from a fall, from April 2021 until April 2022.

Patients were evaluated after discharge by a multifactorial rehabilitation team and randomized into two groups. Questionnaires and objective measurements were used at 2 months after surgery, at 6 and 9 months to assess muscle strength and functional capacity. A telephone interview was conducted at 12 months. Biomarkers (B12,Vit-D, CRP) were also measured by blood tests. Patients in the intervention group followed a modified OTAGO exercise program alongside educational lectures on nutrition and ergonomics.Results: In the intervention group there was an improvement in the level of functional capacity (LEFS) at 6 months as during Mauchly's test, between the measurement at 2 and 6 months it was calculated that there is, statistically, different behavior in the score of the LEFS scale, depending on the group (F=8.715, p=0.006) and between the measurement at 2 and 9 months it was calculated that there is, statistically, different behavior in the score of the LEFS scale, depending on the group (F=2,730, p=0,109). In the Mauchly test between the measurement at 2 and 6 months it was estimated that there is, statistically, different behavior in the score of the EQ-5D-5L scale depending on the group (F=13.313, p<0.001) between the measurement at 2 and 9 months (F=15.089, p<0.001) and between the measurement at 2 and 12 months (F=16.458, p<0.001). Based on the Mann-Whitney test between the 2 measurements in the intervention group there was also a decrease in the mean value of CRP while in the control group it remained unchanged (p=0.019).

Conclusions: The implementation of a multifactorial rehabilitation program improves the functional capacity of patients after a hip fracture surgery in a shorter period of time.