Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in ... more Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in the community. The causes of poor recovery are not fully understood. This study investigates recovery of walking outdoors and associated determinants after hip fracture. Methods. A prospective follow-up study, among clinical sample of 81 community-dwelling hip fracture patients over 60 years. Perceived difficulty in walking outdoors and 500 meters was assessed before fracture, at discharge to home (3.2 ± 2.2 weeks after surgery), and on average 6.0 ± 3.3 weeks after discharge. Potential determinants for walking recovery were assessed. Linear latent trajectory model was used to analyse changes during follow-up. Association between walking trajectories and potential determinants was analysed with a logistic regression model. Results. Two trajectories, No-to-minor-difficulty and Catastrophic, were found. Thirty-eight percent of the participants ended up in the Catastrophic trajectory for walking outdoors and 67% for 500 meters. Multivariate logistic regression analysis revealed that use of walking aid and indoor falls before fracture and prolonged pain were independently associated with catastrophic decline in both primary outcomes: difficulty in walking outdoors and 500 meters. Conclusions. A large proportion of community-dwelling older people recovering from hip fracture experienced catastrophic decline in outdoor walking. Acknowledging recovery prognoses at early stage enables individualized rehabilitation.
Objectives. To study effects of a one-year multicomponent intervention on perceived environmental... more Objectives. To study effects of a one-year multicomponent intervention on perceived environmental barriers in hip fracture patients. Design. Randomized controlled trial of a 12-month home-based rehabilitation aiming to improve mobility and function (ISRCTN53680197); secondary analyses. Subjects. Community-dwelling hip fracture patients on average 70 days after trauma ( = 81). Methods. Assessments at baseline, 3, 6, and 12 months later included perceived entrance-related barriers (e.g., indoor/outdoor stairs, lighting, floor surfaces, and storage for mobility devices) and perceived barriers in the outdoor environment (poor street condition, hilly terrain, long-distances, and lack of resting places). Sum scores for entrance-related and outdoor barriers were analyzed using general estimating equation models. Results. At baseline, 48% and 37% of the patients perceived at least one entrancerelated barrier, and 62% and 60% perceived at least one outdoor barrier in the intervention and control group, respectively. Over time, ( = 0.003) the number of entrance-related barriers decreased in both groups (group = 0.395; interaction = 0.571). For outdoor barriers, time ( = 0.199), group ( = 0.911), and interaction effect ( = 0.430) were not significant. Conclusion. Our intervention had no additional benefit over standard care in hip fracture patients. Further study is warranted to determine whether perceived environmental barriers can be reduced by interventions targeted at the older individual. This trial is registered with ISRCTN53680197.
Journal of the American Medical Directors Association, 2014
Hip fracture rehabilitation mobility disablement process reenablement a b s t r a c t Objective: ... more Hip fracture rehabilitation mobility disablement process reenablement a b s t r a c t Objective: To investigate whether a home-based rehabilitation program for community-dwelling older people with recent hip fracture is more effective than standard care in improving mobility recovery and reducing disability. Design: Randomized, controlled, parallel-group trial. Setting: Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. Participants: Clinical population of community-dwelling men and women (aged 60þ) recovering from hip fracture. Participants were randomly assigned into control (n ¼ 41) or intervention (n ¼ 40) groups on average 42 AE 23 days after discharge home. Intervention: A yearlong multicomponent home-based rehabilitation aimed at promoting mobility recovery and physical functional capacity after hip fracture. The intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, a progressive home exercise program, physical activity counseling, and standard care. Measurements: Measurements were outlined according to the tiers of the disablement process, with the ability to negotiate stairs as the main outcome. Prefracture ability to negotiate stairs was enquired at the hospital on average 10 AE 5 days after fracture. Subsequently, current perceived ability to negotiate stairs was reported immediately before the intervention (on average 9 weeks after surgery) and 3, 6, and 12 months thereafter. Other measurements included leg extension power deficit (LEP), functional balance (Berg Balance Scale) and lower extremity performance (Short Physical Performance Battery). Effects of the intervention were analyzed with generalized estimation equations and longitudinal repeated measures mixture path models. Results: The intervention reduced perceived difficulties in negotiating stairs (interaction, group  time P ¼ .001) from prefracture to 12 months compared with the control condition. The mixture path model revealed that less difficulty in negotiating stairs at 6 and 12 months correlated with better functional balance at 3 and 6 months in the intervention group but not controls (group difference P ¼ .007 and P < .001, respectively). Conclusion: The individualized home-based rehabilitation program improved mobility recovery after hip fracture over standard care. To be efficacious in reducing or reversing disability after hip fracture, rehabilitation needs to be individualized, include many components, be progressive, and span a sufficiently long period. Current Controlled Trials (ISRCTN53680197).
This cross-sectional study investigated the associations between balance confidence, functional b... more This cross-sectional study investigated the associations between balance confidence, functional balance, and physical disability among older people after hip fracture. The study utilizes baseline data of two randomized controlled trials (ISRCTN34271567 and ISRCTN53680197). The participants were 159 community-dwelling over 60-year-old people. Health, fracture status, the date and type of surgery, and contraindications for participation were assessed in a clinical examination. Balance confidence was assessed by the Activities-specific Balance Confidence Scale (ABC) and functional balance by the Berg Balance Scale. Physical disability was assessed by a questionnaire containing 14 questions on perceived difficulty in basic (ADL) and instrumental activities of daily living (IADL). Two sum scores were composed: ADL score (range 0-6) and IADL score (range 0-8). Isometric knee extension force was measured using a dynamometer. Pain and use of walking aids were assessed by a questionnaire. The negative binomial regression analysis was used to analyze the associations. A higher ABC score was associated with a lower risk for ADL (IRR 0.99; 95% CI 0.98-0.99) and IADL disability (0.99; 0.98-0.99) in the fully adjusted models. Also a higher BBS score was associated with a lower risk for ADL (0.98; 0.96-0.99) and IADL disability (0.98; 0.97-0.99) in the fully adjusted models. Decreased balance confidence and impaired functional balance are associated with physical disability in older people after hip fracture.
Archives of Physical Medicine and Rehabilitation, 2012
Portegijs E, Edgren J, Salpakoski A, Kallinen M, Rantanen T, Alen M, Kiviranta I, Sihvonen S, Sip... more Portegijs E, Edgren J, Salpakoski A, Kallinen M, Rantanen T, Alen M, Kiviranta I, Sihvonen S, Sipilä S. Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study. Arch Phys Med Rehabil 2012;93:2340-6.
Background: To cope at their homes, community-dwelling older people surviving a hip fracture need... more Background: To cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture. Methods/Design: Population-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMointervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables. Discussion: Ten weeks post hip fracture only half of the participants were compliant to Standard Care. No followup for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study.
Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in ... more Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in the community. The causes of poor recovery are not fully understood. This study investigates recovery of walking outdoors and associated determinants after hip fracture. Methods. A prospective follow-up study, among clinical sample of 81 community-dwelling hip fracture patients over 60 years. Perceived difficulty in walking outdoors and 500 meters was assessed before fracture, at discharge to home (3.2 ± 2.2 weeks after surgery), and on average 6.0 ± 3.3 weeks after discharge. Potential determinants for walking recovery were assessed. Linear latent trajectory model was used to analyse changes during follow-up. Association between walking trajectories and potential determinants was analysed with a logistic regression model. Results. Two trajectories, No-to-minor-difficulty and Catastrophic, were found. Thirty-eight percent of the participants ended up in the Catastrophic trajectory for walking outdoors and 67% for 500 meters. Multivariate logistic regression analysis revealed that use of walking aid and indoor falls before fracture and prolonged pain were independently associated with catastrophic decline in both primary outcomes: difficulty in walking outdoors and 500 meters. Conclusions. A large proportion of community-dwelling older people recovering from hip fracture experienced catastrophic decline in outdoor walking. Acknowledging recovery prognoses at early stage enables individualized rehabilitation.
Objectives. To study effects of a one-year multicomponent intervention on perceived environmental... more Objectives. To study effects of a one-year multicomponent intervention on perceived environmental barriers in hip fracture patients. Design. Randomized controlled trial of a 12-month home-based rehabilitation aiming to improve mobility and function (ISRCTN53680197); secondary analyses. Subjects. Community-dwelling hip fracture patients on average 70 days after trauma ( = 81). Methods. Assessments at baseline, 3, 6, and 12 months later included perceived entrance-related barriers (e.g., indoor/outdoor stairs, lighting, floor surfaces, and storage for mobility devices) and perceived barriers in the outdoor environment (poor street condition, hilly terrain, long-distances, and lack of resting places). Sum scores for entrance-related and outdoor barriers were analyzed using general estimating equation models. Results. At baseline, 48% and 37% of the patients perceived at least one entrancerelated barrier, and 62% and 60% perceived at least one outdoor barrier in the intervention and control group, respectively. Over time, ( = 0.003) the number of entrance-related barriers decreased in both groups (group = 0.395; interaction = 0.571). For outdoor barriers, time ( = 0.199), group ( = 0.911), and interaction effect ( = 0.430) were not significant. Conclusion. Our intervention had no additional benefit over standard care in hip fracture patients. Further study is warranted to determine whether perceived environmental barriers can be reduced by interventions targeted at the older individual. This trial is registered with ISRCTN53680197.
Journal of the American Medical Directors Association, 2014
Hip fracture rehabilitation mobility disablement process reenablement a b s t r a c t Objective: ... more Hip fracture rehabilitation mobility disablement process reenablement a b s t r a c t Objective: To investigate whether a home-based rehabilitation program for community-dwelling older people with recent hip fracture is more effective than standard care in improving mobility recovery and reducing disability. Design: Randomized, controlled, parallel-group trial. Setting: Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. Participants: Clinical population of community-dwelling men and women (aged 60þ) recovering from hip fracture. Participants were randomly assigned into control (n ¼ 41) or intervention (n ¼ 40) groups on average 42 AE 23 days after discharge home. Intervention: A yearlong multicomponent home-based rehabilitation aimed at promoting mobility recovery and physical functional capacity after hip fracture. The intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacological pain management, a progressive home exercise program, physical activity counseling, and standard care. Measurements: Measurements were outlined according to the tiers of the disablement process, with the ability to negotiate stairs as the main outcome. Prefracture ability to negotiate stairs was enquired at the hospital on average 10 AE 5 days after fracture. Subsequently, current perceived ability to negotiate stairs was reported immediately before the intervention (on average 9 weeks after surgery) and 3, 6, and 12 months thereafter. Other measurements included leg extension power deficit (LEP), functional balance (Berg Balance Scale) and lower extremity performance (Short Physical Performance Battery). Effects of the intervention were analyzed with generalized estimation equations and longitudinal repeated measures mixture path models. Results: The intervention reduced perceived difficulties in negotiating stairs (interaction, group  time P ¼ .001) from prefracture to 12 months compared with the control condition. The mixture path model revealed that less difficulty in negotiating stairs at 6 and 12 months correlated with better functional balance at 3 and 6 months in the intervention group but not controls (group difference P ¼ .007 and P < .001, respectively). Conclusion: The individualized home-based rehabilitation program improved mobility recovery after hip fracture over standard care. To be efficacious in reducing or reversing disability after hip fracture, rehabilitation needs to be individualized, include many components, be progressive, and span a sufficiently long period. Current Controlled Trials (ISRCTN53680197).
This cross-sectional study investigated the associations between balance confidence, functional b... more This cross-sectional study investigated the associations between balance confidence, functional balance, and physical disability among older people after hip fracture. The study utilizes baseline data of two randomized controlled trials (ISRCTN34271567 and ISRCTN53680197). The participants were 159 community-dwelling over 60-year-old people. Health, fracture status, the date and type of surgery, and contraindications for participation were assessed in a clinical examination. Balance confidence was assessed by the Activities-specific Balance Confidence Scale (ABC) and functional balance by the Berg Balance Scale. Physical disability was assessed by a questionnaire containing 14 questions on perceived difficulty in basic (ADL) and instrumental activities of daily living (IADL). Two sum scores were composed: ADL score (range 0-6) and IADL score (range 0-8). Isometric knee extension force was measured using a dynamometer. Pain and use of walking aids were assessed by a questionnaire. The negative binomial regression analysis was used to analyze the associations. A higher ABC score was associated with a lower risk for ADL (IRR 0.99; 95% CI 0.98-0.99) and IADL disability (0.99; 0.98-0.99) in the fully adjusted models. Also a higher BBS score was associated with a lower risk for ADL (0.98; 0.96-0.99) and IADL disability (0.98; 0.97-0.99) in the fully adjusted models. Decreased balance confidence and impaired functional balance are associated with physical disability in older people after hip fracture.
Archives of Physical Medicine and Rehabilitation, 2012
Portegijs E, Edgren J, Salpakoski A, Kallinen M, Rantanen T, Alen M, Kiviranta I, Sihvonen S, Sip... more Portegijs E, Edgren J, Salpakoski A, Kallinen M, Rantanen T, Alen M, Kiviranta I, Sihvonen S, Sipilä S. Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study. Arch Phys Med Rehabil 2012;93:2340-6.
Background: To cope at their homes, community-dwelling older people surviving a hip fracture need... more Background: To cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture. Methods/Design: Population-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMointervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables. Discussion: Ten weeks post hip fracture only half of the participants were compliant to Standard Care. No followup for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study.
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Papers by Johanna Edgren