Community Ambulation Following Hip Fracture

Summary

Principal Investigator: Jay Magaziner
Abstract: DESCRIPTION (provided by applicant): The ability to ambulate in the community is of critical importance for carrying out daily activities;yet 50% of hip fracture patients who walked independently before a fracture require assistance to walk 10 feet a year later, and many of those that are able to walk without assistance move so slowly that they are no longer able to walk a distance considered adequate for community ambulation. The proposed study will evaluate the ability of a high intensity, 16-week, multi-component exercise program beginning two months post-fracture to improve patients'ability to walk a community ambulation distance at 4 months post-initiation of the program. Forty exercise sessions will be provided in patients'place of residence under the direct supervision of physical therapists;exercises will be targeted to improve endurance, balance, muscle strength, and functional task performance. This two group randomized clinical trial will determine if a 16-week training program can improve patients'ability to walk a community ambulation distance of 300 meters in six minutes at 4 months following randomization. Three clinical sites (University of Maryland Baltimore;Arcadia University;University of Connecticut Health Center) will recruit a total of 300 community dwelling hip fracture patients (aged 65+) following hospitalization, and randomly assign them to a 16-week high intensity, supervised, home delivered multi-component exercise program or a control intervention consisting of stretching and range of motion exercises, and low level transcutaneous electrical stimulation. Patients will be randomized after standard post- acute rehabilitative care ends (2 months post-fracture). Patients in both groups will receive supplemental vitamin D3, calcium, a multivitamin and nutritional counseling to promote weight stability and adequate nutrient intake. The primary endpoint is the ability to walk 300 meters in 6 minutes four months post randomization. Other endpoints include precursors (i.e., endurance, balance, muscle performance, and lower extremity function) and selected underlying mechanisms (i.e., intra-muscular fat, quadriceps volume, circulating inflammatory cytokines, and VO2 peak) to community ambulation. Cost effectiveness also will be evaluated. The study is designed to detect at least a 20 percentage point difference between the exercise and control groups in the primary outcome with 90 percent power (alpha=. 05) in an intention to treat analysis. Results will lead to a better understanding of the dynamics of innovative post hip fracture physical therapy. Implications of study findings will relate directly to hip fracture patients'ability to ambulate independently in the community and the cost-effectiveness of the proposed intervention. PUBLIC HEALTH RELEVANCE: More than 325,000 hip fractures occur annually in the US, with associated health care costs estimated at $14-20 billion. The goal of current clinical practice is independent, safe household ambulation, at 2-3 months post surgery, yet hip fracture-acquired dependency persists well beyond three months. This study will evaluate a 16-week multi-component exercise program provided to patients in their homes to determine if it is effective in improving the ability to walk independently in the community (i.e., community ambulation).
Funding Period: 2010-09-01 - 2016-05-31
more information: NIH RePORT

Research Grants

  1. Effects of Multi-Modal Exercise Intervention Post Hip Fracture
    Jay Magaziner; Fiscal Year: 2013
  2. Boston Puerto Rican Health Study - CVD Risk Factors
    Katherine L Tucker; Fiscal Year: 2013
  3. COllaborative Care to Preserve PErformance in Cancer (COPE) Trial
    Andrea Lynne Cheville; Fiscal Year: 2013
  4. Early Phase Psychosis: Informing Treatment Decisions
    John M Kane; Fiscal Year: 2013
  5. Notch-Mediated Expansion of Cord Blood Progenitors for Stem Cell Transplant
    Colleen Delaney; Fiscal Year: 2013
  6. Mexican Children of Immigrants Program
    Nancy S Landale; Fiscal Year: 2013
  7. OLDER AMERICANS INDEPENDENCE CENTER
    JEREMY DAVID WALSTON; Fiscal Year: 2013
  8. Vermont Center on Behavior and Health
    Stephen T Higgins; Fiscal Year: 2013
  9. INNATE AND ADAPTIVE IMMUNE RESPONSES IN TH2-HIGH ASTHMA
    John V Fahy; Fiscal Year: 2013
  10. Deep South Resource Center for Minority Aging Research
    KATHRYN LARSEN BURGIO; Fiscal Year: 2013

Detail Information

Research Grants61

  1. Effects of Multi-Modal Exercise Intervention Post Hip Fracture
    Jay Magaziner; Fiscal Year: 2013
    ..We also will work with an international group of experts to identify strategies to accelerate development and testing of interventions for this group of older persons who experience this sudden disabling event. ..
  2. Boston Puerto Rican Health Study - CVD Risk Factors
    Katherine L Tucker; Fiscal Year: 2013
    ..abstract_text> ..
  3. COllaborative Care to Preserve PErformance in Cancer (COPE) Trial
    Andrea Lynne Cheville; Fiscal Year: 2013
    ....
  4. Early Phase Psychosis: Informing Treatment Decisions
    John M Kane; Fiscal Year: 2013
    ..Our ability to intervene appropriately, effectively and consistently in this population can have profound long-term public health consequences. ..
  5. Notch-Mediated Expansion of Cord Blood Progenitors for Stem Cell Transplant
    Colleen Delaney; Fiscal Year: 2013
    ..Our goal is to now determine the clinical efficacy of this approach in a phase II clinical trial. ..
  6. Mexican Children of Immigrants Program
    Nancy S Landale; Fiscal Year: 2013
    ..The proposed research will produce essential knowledge for the development of sound public policies and interventions to reduce health disparities. ..
  7. OLDER AMERICANS INDEPENDENCE CENTER
    JEREMY DAVID WALSTON; Fiscal Year: 2013
    ..abstract_text> ..
  8. Vermont Center on Behavior and Health
    Stephen T Higgins; Fiscal Year: 2013
    ..S. public health. ..
  9. INNATE AND ADAPTIVE IMMUNE RESPONSES IN TH2-HIGH ASTHMA
    John V Fahy; Fiscal Year: 2013
    ..Including studies in human biospecimens in a PPG that promises to advance understanding of airway TH2 inflammation in ways that are highly relevant to patients with asthma. ..
  10. Deep South Resource Center for Minority Aging Research
    KATHRYN LARSEN BURGIO; Fiscal Year: 2013
    ....
  11. Group Physical Therapy for Veterans with Knee Osteoarthritis
    Kelli D Allen; Fiscal Year: 2013
    ..Mixed linear models will be used to compare outcomes for the two study arms. We will also conduct an economic analysis of the group-based PT program. ..
  12. Reducing Dynamic Hyperinflation through Breathing Retraining
    Eileen G Collins; Fiscal Year: 2013
    ..Multiple regression analysis will be employed to determine the predictors of improved exercise performance. ..
  13. SPINAL CIRCUITS AND THE MUSCULOSKELETAL SYSTEM
    Arthur W English; Fiscal Year: 2013
    ..This PPG brings together a team of established scientists from diverse backgrounds, with a common goal to continue to strengthen the science base underlying clinical rehabilitation. ..
  14. Heart-Brain Retraining: Forced Aerobic exercise for Stroke Rehabilitation
    SUSAN MARIE LINDER; Fiscal Year: 2013
    ..If forced exercise is shown effective, it could become a viable adjunct to current neurorehabilitation approaches in driving neural recovery while simultaneously improving cardiovascular health. ..
  15. Intervention to Enhance Lateral Balance Function and Prevent Falls in Aging
    Mark W Rogers; Fiscal Year: 2013
    ....
  16. Rush Center for Urban Health Equity
    Lynda H Powell; Fiscal Year: 2013
    ..Funding is now sought to bring these resources together to establish a unique center of excellence in health disparities interventions. ..
  17. STUDIES OF JOINT AGING AND OSTEOARTHRITIS
    Martin K Lotz; Fiscal Year: 2013
    ..Sah) will analyze biomechanical mechanisms of early and advanced cartilage degeneration and determine consequences for chondrocyte function and survival. ..
  18. Bridging Research, Innovation, Training &Education Solutions for Minority Health
    Vickie M Mays; Fiscal Year: 2013
    ..abstract_text> ..
  19. Promoting Independence Through Pain and Symptom Management
    Albert L Siu; Fiscal Year: 2013
    ..The proposed Center will bridge geriatrics and palliative care and serve as a model for a new focused area of research within geriatrics. ..
  20. Trial of Physical Activity Self-management Intervention for Patients with COPD
    David B Coultas; Fiscal Year: 2013
    ..The project addresses a major gap in the current management of COPD and may provide a novel, cost-effective strategy for improving functional performance and health status. ..
  21. Penn TREC Survivor Center
    Kathryn H Schmitz; Fiscal Year: 2013
    ..abstract_text> ..
  22. COMBINING TESTOSTERONE THERAPY AND EXERCISE TO IMPROVE FUNCTION POST HIP FRACTURE
    Kenneth B Schechtman; Fiscal Year: 2013
    ....
  23. Reducing disability via a bundled bio-behavioral-environmental approach
    Sarah L Szanton; Fiscal Year: 2013
    ..05) in an intention to treat analysis. The innovative study will provide economic evidence for a theory-driven intervention that could rein in costs of a growing and increasingly diverse older adult population. ..
  24. COBRE Center for Central Nervous System Function
    Jerome N Sanes; Fiscal Year: 2013
    ..The COBRE Center will leverage the administrative resources available through the Brown Institute for Brain Science to ensure efficient operation and coordinate with other brain science research activities at Brown. ..
  25. Hopkins Center for Eliminate Cardiovascular Health Disparities
    Lisa A Cooper; Fiscal Year: 2013
    ..abstract_text> ..
  26. Sensor Activity Monitoring, Feedback, and Outcome Measures, Stroke Rehabilitation
    Bruce H Dobkin; Fiscal Year: 2013
    ..This study will be the first comprehensive demonstration of mHealth remote monitoring and outcome measures of daily physical activity! ..
  27. Exploring Tai Chi as a Behavioral Intervention for Heart Failure Patients
    Laura S Redwine; Fiscal Year: 2013
    ..Historically, HF patients were counseled to limit physical activities. However, recent studies show that moderate exercise can be performed safely in properly evaluated NYHA II-III HF patients. ..
  28. Examining the Effects of High Protein Diet on Outcomes in Heart Failure Patients
    Lorraine S Evangelista; Fiscal Year: 2013
    ..This information will provide evidence for rational recommendations for weight loss modalities that can be integrated in HF management and treatment guidelines. ..
  29. Reducing Gait Asymmetry in Lower-LImb Amputees Using Real-Time Rehab to Train-to-
    Stacy J Morris Bamberg; Fiscal Year: 2013
    ....
  30. Vitamin D Effect on Body Composition During Behavioral Weight Loss in Women
    ANNE M MCTIERNAN; Fiscal Year: 2013
    ....
  31. Tailored Lifestyle Intervention in Obese Adults within Primary Care Practice
    Charles B Eaton; Fiscal Year: 2013
    ..This study will fill an important gap in our knowledge regarding the translation and dissemination of research from efficacy studies to best practices in the community settings- an important objective of the NIH Roadmap Initiative. ..
  32. SCHS, mitochondria, healthy aging and longevity
    Gino A Cortopassi; Fiscal Year: 2013
    ..abstract_text> ..
  33. The LIFE Study
    Marco Pahor; Fiscal Year: 2013
    ..The proposed trial will provide definitive evidence regarding whether physical activity is effective and practical for preventing major mobility disability. ..
  34. Cellular Senescence and Aging
    James L Kirkland; Fiscal Year: 2013
    ..Our approach will provide timely, innovative, and clinically relevant interventional results based on addressing the fundamental question of the role of cellular senescence that has remained unanswered for many years. ..
  35. JointADventure: A Worksite Activity-Diet Intervention for Chronic Knee Pain
    Rowland W Chang; Fiscal Year: 2013
    ....
  36. Improving pain and function in hip fracture
    R Sean Morrison; Fiscal Year: 2013
    ..abstract_text> ..
  37. PROMISE Trial: EQOL Coordinating Center
    Daniel B Mark; Fiscal Year: 2013
    ....
  38. Cooperative Lifestyle Intervention Programs (CLIP-II)
    WALTER JOHN REJESKI; Fiscal Year: 2013
    ..The primary outcomes will be mobility disability and muscle strength. ..