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H. Dahan1, Y. Masharawi2, A. Hershkovitz3
1Clalit Health Services "Beit-Rivka" Geriatric Rehabilitation Center and Tel-Aviv University, Physical Therapy, Petach-Tikva, Israel, 2Tel-Aviv University, The Stanley Steyer School of Health Professions, Tel-Aviv, Israel, 3"Beit-Rivka" Geriatric Rehabilitation Center and Sackler School of Medicine, Tel Aviv University, Petach-Tikva, Israel
Background: The challenge of a post-acute rehabilitation program is to improve the patients’ functional ability to a level that will facilitate their return home.Albeit, there are diverse intervention programs, such as early mobilization, functional and progressive resistance training, WB exercises, and neuromuscular stimulation, however, in the absence of evidence-based data, their effectiveness is questionable. Hence, verification as to the benefits of optimal intervention programs in maximizing post hip-fracture functional recovery, is essential.
Leg-cycle ergometry is one of the components of a physical training modality in rehabilitation. Whilst sitting in a supported position, the patient is able to cycle and activate lower limb muscles without overloading stress on the fractured leg. As there are similarities in the muscular activities during the extension phase in recumbent cycling, sit to stand and step-up, cycling is considered to be an effective training modality, mainly in the post-acute phase, when standing and walking are demanding functional tasks. The physical benefits and rehabilitation advantages of cycling has been studied mainly in healthy older adults and stroke patients in the subacute or chronic phases. Less is known as to the impact of leg-cycling training on hip-fractured elderly patients during the early phases of rehabilitation.
Leg-cycle ergometry is one of the components of a physical training modality in rehabilitation. Whilst sitting in a supported position, the patient is able to cycle and activate lower limb muscles without overloading stress on the fractured leg. As there are similarities in the muscular activities during the extension phase in recumbent cycling, sit to stand and step-up, cycling is considered to be an effective training modality, mainly in the post-acute phase, when standing and walking are demanding functional tasks. The physical benefits and rehabilitation advantages of cycling has been studied mainly in healthy older adults and stroke patients in the subacute or chronic phases. Less is known as to the impact of leg-cycling training on hip-fractured elderly patients during the early phases of rehabilitation.
Purpose: The aim of this study was to examine the impact of leg-cycle training, as a part of physiotherapy treatment, on the performance of post-acute hip-fractured elderly patients during rehabilitation.
Methods: Design: Randomized, blinded control trial.
Setting: Post-acute geriatric rehabilitation center
Intervention: Patients were randomly assigned into a “cycling group” (intervention) (n=21) and a “music listening group” (controls) (n=20). Both groups received 30 minutes of standard physiotherapy supplemented by 20 minutes of intervention (5 days/week for three weeks).
Measurements: Functional independence measure, weight bearing while standing (TETRAX postural platform plates), quadriceps strength, grip strength (hand-held dynamometer), and pain intensity (visual analogue scale). Assessments were performed on admission and one and three weeks later. The chi-square test assessed the associations between type of intervention and demographics, clinical data and data relating to the fracture. The Friedman test assessed the differences between the first and the last measures in each group. The Mann-Whitney U test evaluated the differences in the degree of functional measures improvement between the two groups.
Setting: Post-acute geriatric rehabilitation center
Intervention: Patients were randomly assigned into a “cycling group” (intervention) (n=21) and a “music listening group” (controls) (n=20). Both groups received 30 minutes of standard physiotherapy supplemented by 20 minutes of intervention (5 days/week for three weeks).
Measurements: Functional independence measure, weight bearing while standing (TETRAX postural platform plates), quadriceps strength, grip strength (hand-held dynamometer), and pain intensity (visual analogue scale). Assessments were performed on admission and one and three weeks later. The chi-square test assessed the associations between type of intervention and demographics, clinical data and data relating to the fracture. The Friedman test assessed the differences between the first and the last measures in each group. The Mann-Whitney U test evaluated the differences in the degree of functional measures improvement between the two groups.
Results: Quadriceps strength of the operated leg significantly improved in the intervention group compared to the controls:78% vs. 34.9%, respectively (p<0.006). This group also reported a significantly (p<0.001) lower pain intensity and a better weight bearing ability (p=0.028) than the controls. No significant differences were found between the intervention and controls as to demographic and clinical parameters.
Conclusion(s): Leg-cycle training is an important training modality that may significantly improve quadriceps strength, weight bearing and reduce pain intensity in elderly hip-fractured patients. This practical and easily applicable modality may contribute in rehabilitating post-acute hip-fractured patients.
Implications: Leg cycle ergometer greatly benefits hip-fractured elderly patients during rehabilitation, as it simultaneously enables reciprocal work and strengthening of both lower limbs.
This practice may significantly improve quadriceps strength, weight bearing and reduce pain intensity in elderly hip-fractured patients.
This practice may significantly improve quadriceps strength, weight bearing and reduce pain intensity in elderly hip-fractured patients.
Funding, acknowledgements: The work is unfunded
Keywords: Geriatric Rehabilitation, Hip Fracture, Physiotherapy
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Clalit Health Services and Tel-Aviv University
Committee: Rabin Medical Center review board
Ethics number: 0495-14-RMC
All authors, affiliations and abstracts have been published as submitted.
