From Medscape Medical News
Nancy A. Melville
September 22, 2009 (Denver, Colorado) — Extended physiotherapy, along with high-dose supplementation of vitamin D, after hip fracture can significantly improve the rate of falls and hospital readmissions for the elderly, according to a study presented here at the American Society for Bone and Mineral Research (ASBMR) 31st Annual Meeting.
High rates of post-hip-fracture morbidity and mortality are a heavy socioeconomic burden, yet there are no well-established guidelines for postfracture care among the elderly, said lead author Heike A. Bischoff-Ferrari, MD, professor of medicine at the University of Zurich in Switzerland. "Guidelines for postfracture care of elderly hip-fracture patients are not established, despite the fact that in the first 12 months after hip fracture, 5% to 10% of patients fracture their other hip, 30% are readmitted to acute care, 50% are left with permanent functional decline, 25% require long-term care, and 10% to 25% die," Dr. Bischoff-Ferrari said in an interview with Medscape Ob/Gyn & Women's Health.
To determine whether a strategy combining a home-based physiotherapy program and a vitamin D regimen could reduce some of the sequelae of hip fracture, the researchers enrolled 173 acute hip-fracture patients in their study; 79% were women with a mean age of 84 years and 77% were living in the community.
The researchers compared the effects of extended physiotherapy, which consisted of 1 hour of supervised physiotherapy per day during acute care plus an unsupervised home physiotherapy program, with those of standard physiotherapy, which consisted of 30 minutes of supervised physiotherapy per day during acute care and no home program.
The home-based physiotherapy involved basic exercises, such as getting in and out of a chair, balancing on 1 leg, walking up and down stairs, and a simple rubber-band exercise for upper-arm strength, Dr. Bischoff-Ferrari said.
The researchers also assessed the effects of 2000 IU of vitamin D3 per day, compared with 800 IU units per day, and the effect that the combined physiotherapy and vitamin D3 components had on the rate of falls and readmissions to the hospital.
Over the course of a 12-month follow-up, the researchers documented a total of 212 falls, with a rate of 1.43 falls per observed patient-year, and 74 hospital readmissions, with a rate of 0.5 per observed patient-year.
Falls among patients in the extended physiotherapy group were significantly reduced by 25%. Patients taking 2000 IU of vitamin D had a rate of hospital readmission that was 39% lower than those taking 800 IU of vitamin D per day.
The lower readmission rate could be explained by the 60% reduction in fall-related injuries and the 90% reduction in infections leading to inpatient care seen among the higher-dose vitamin D group, Dr. Bischoff-Ferrari said.
"Our study demonstrated that an extended physiotherapy program, together with 2000 IU of vitamin D, has complementary benefits for post-hip-fracture care, including a significant 25% reduction in falls and a 39% reduction in hospital readmission," she said. "This regimen could have an exceptional benefit on improving post-hip-fracture care for the elderly."
Jonathan D. Adachi, MD, professor of medicine at McMaster University in Hamilton, Ontario, said the study is particularly notable, not just for the improvements seen with the extended physiotherapy, but for the role of vitamin D.
"The study is very important because it demonstrates the benefit of both vitamin D and physiotherapy," said Dr. Adachi, who was not involved in the study.
"What is particularly important is the dose of vitamin D; most guidelines do not recommend this high a dose of vitamin D and many doctors do not recommend this dose of 2000 IU."
American Society for Bone and Mineral Research (ASBMR) 31st Annual Meeting: Abstract 1097. Presented September 12, 2009.
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