Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people.

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. ProMo-intervention 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 follow-up 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. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53680197.

Genetics of maximal walking speed and skeletal muscle characteristics in older women.

The aim of this study was to examine whether maximal walking speed, maximal isometric muscle strength, leg extensor power and lower leg muscle cross-sectional area (CSA) shared a genetic effect in common. In addition, we wanted to identify the chromosomal areas linked to maximal walking speed and these muscle characteristics and also investigate whether maximal walking speed and these three skeletal muscle characteristics are regulated by the same chromosomal areas. We studied 217 monozygotic (MZ) and dizygotic (DZ) female twin pairs aged 66 to 75 years in the Finnish Twin Study on Aging study. The DZ pairs (94) were genotyped for 397 microsatellite markers in 22 autosomes and X-chromosome. Genetic modeling showed that, muscle CSA, strength, power and walking speed shared a genetic effect in common which accounted for 7% of the variation in CSA, 51% in strength, 37% in power and 35% in walking speed. The results of an explorative multipoint linkage analysis suggested that the highest LOD score found for each phenotype was 2.41 for walking speed on chromosome 13q22.1, 2.14 for strength on chromosome 15q14, 2.84 for power on chromosome 8q24.23, and 2.93 for muscle CSA on chromosome 20q13.31. Also a suggestive LOD score, 2.68, for muscle CSA was found on chromosome 9q34.3. The chromosomal areas of a suggestive linkage for strength and power partly overlapped LOD scores higher than 1.0 being seen for these phenotypes on chromosome 15. The present study was the first genome-wide linkage analysis to be conducted for these multifactorial and clinically important phenotypes underlying functional independence in older women.