Comparison of Anterior Ankle Translation With and Without Ankle Braces.

BACKGROUND: Lateral ankle sprains are a common musculoskeletal injury. Ankle braces are frequently used to prevent ankle injuries. AIM: The purpose of this study was to examine the anterior translation of the talocrural joint of 2 ankle braces relative to a control. METHODS: Ankle mobility was assessed with the Mobil-Aider arthrometer in 3 conditions: TayCo ankle brace, Aircast ankle brace, and control. Three measures were recorded for each condition. RESULTS: Thirty participants (9 male and 21 female patients) participated. Friedman's analysis of variance found significant between-group differences for the trial with the largest translation. Wilcoxon signed-ranks post hoc testing found significant between-group differences between the control and TayCo (P < .001) and the control and Aircast conditions (P < .001). Post hoc power analysis revealed a Kendall's W of 0.804. CLINICAL APPLICATION: The TayCo brace is unique in that it is worn on the outside of the athletic shoe, whereas the Aircast is composed of lateral constraints worn inside the shoe. Both braces provided significant constraint over anterior talus translation when compared to control. The TayCo brace (51%-52% of control) was also significantly better than the Aircast (58%-59% of control) with less anterior translation permitted. This may be instrumental in preventing ankle injuries. LEVEL OF EVIDENCE: 2b.

Assessing Lateral Ankle Sprains With a New Arthrometer.

BACKGROUND: Lateral ankle sprains are a common musculoskeletal injury across a variety of activities. Researchers have sought to identify a method to objectively assess joint laxity with a device that is simple to use and affordable. AIM: The purpose of this study was to assess the use of an ankle arthrometer on individuals with ankle sprains. METHODS: The participant was evaluated by the physician and the degree of ankle sprain was identified. In the prone position, the arthrometer was used to perform an anterior drawer test (uninjured before injured, 3 measures each). Both clinicians were blinded to the data of the other. RESULTS: There were 30 participants, 10 in each group (uninjured, grade 1 sprain, grade 2 sprain). Mann-Whitney U testing found significant differences between the control and grade I ankle sprain groups (P < .001), the control and grade II ankle sprain groups (P < .001), and the grade I and grade II ankle sprain groups (P = .004). There was ±0.31-mm difference in anterior translation between healthy ankles, whereas there was 1.11- and 2.16-mm difference between ankles in grade 1 and grade 2 sprains, respectively. CLINICAL APPLICATION: Despite the manual anterior drawer test being convenient, the subjectivity makes it unreliable. This study is consistent with prior literature about the difference in translation (millimeters) between the uninjured and injured ankles corresponding to the magnitude of ankle laxity. This study also contributes to the evolving evidence to support the relationship of a ratio of measures (injured/uninjured) as an objective measure of laxity. These comparisons to the individual's healthy ankle mitigate the variability of the normative values. The use of an arthrometer to assess ankle joint laxity enhances the objectivity of patient assessment throughout the recovery process. LEVELS OF EVIDENCE: Level III.

Mindfulness and Acceptance-Based Interventions in Physical Therapist Practice: The Time Is Now.

One in 5 adults in the United States lives with a mental illness, and many more struggle with stress-related chronic illnesses. Physical therapists often see the physical effects that stress has on the body, but there is an underutilization of evidence-based stress management strategies with patients and clients. Mindfulness and acceptance-based interventions (MABIs) constitute a family of methods that emphasize present-moment awareness, nonjudgment, and values-based living. They operate by teaching patients to cope with stressful thoughts, emotions, and physical sensations. MABIs are associated with improved health outcomes in areas commonly seen in physical therapist practice, including health promotion, physical function, injury prevention, pain management, immune function, and noncommunicable diseases. The purpose of this Perspective article is to (1) describe MABIs; (2) discuss the relevance of MABIs to physical therapist practice; (3) discuss the positive impact of MABIs for pain, sports, immune function, physical and mental health promotion, and wellness; and (4) identify MABI outcome measures related to health behavior change. It is time. IMPACT: Contemporary practice requires that physical therapists manage patient care by addressing both the mind and body. Given the existing research on MABIs, it is time to translate the evidence into minimum accreditable standards for health promotion and prevention of chronic, noncommunicable disease. This approach would have far-reaching benefits for individuals, family units, communities, and society as a whole. LAY SUMMARY: Mindfulness instruction delivered by a physical therapist can help improve physical and mental well-being.

High Civic-Mindedness Reduces Compassion Fatigue in the First 3 Years of Professional Physical Therapist Practice: A Pilot Study.

INTRODUCTION: Clinicians with compassion fatigue (CF) experience behavioral, cognitive, and emotional changes due to repeated exposure to second-hand trauma from the clients with whom they are working. A civic-minded professional possesses the core value of social responsibility. Physical therapy (PT) education programs must balance a focus on developing social responsibility and compassion against the risk of CF. OBJECTIVE: The objectives of this study were to (1) describe the prevalence of CF in a sample of physical therapists in the early years of practice and (2) to determine whether higher civic-mindedness leads to the development of CF in physical therapists. METHOD: Three cohorts of recent graduates were administered the Professional Quality of Life (Pro-QOL) survey to measure CF. Thirty-five of 127 surveys sent (27.6% response rate) were completed. RESULTS: A Mann-Whitney U was run to determine differences in the Pro-QOL survey between those scoring high or low in civic-mindedness at graduation. Higher civic-mindedness scores exhibited significantly lower burnout and higher compassion satisfaction. CONCLUSION: Higher levels of civic-mindedness appear to have a protective effect against developing CF.

Civic-Mindedness Sustains Empathy in a Cohort of Physical Therapy Students: A Pilot Cohort Study.

BACKGROUND: Empathy is critical to patient-centered care and thus is a valued trait in graduate health-care students. The relationship between empathy and civic-mindedness in health professions has not previously been explored. OBJECTIVES: (a) To determine whether significant differences occurred on the Jefferson Scale for Empathy-Health Professions Student Version (JSE-HPS) and Civic-Minded Professional scale (CMP) and its subscales across the curriculum, (b) to explore a potential relationship between civic-mindedness and empathy in a cohort of graduate physical therapy (PT) students at regular intervals, and (c) to explore the predictive ability of civic-mindedness on empathy scores. METHODS: This study was a convenience sample of a cohort of 48 PT students who completed both the JSE-HPS and the CMP at 4 points of a service-learning intensive curriculum. Statistical analysis included descriptive statistics, a Friedman's analysis of variance with Wilcoxon signed-ranks post hoc testing, and Spearman correlations with stepwise linear regressions. RESULTS: Statistically significant differences were not found for the JSE-HPS. Civic-Minded Professional scores increased across the curriculum. The JSE-HPS, the CMP, and various CMP subscales were significantly correlated. The JSE-HPS pretest scores were predictive of the year 1 and 2 posttest JSE-HPS scores. CONCLUSION: This study's findings indicate that service-learning and the resulting development of civic-mindedness supports empathy. Programs could use JSE-HPS pretests to identify individual graduate students need for empathy mentorship upon program entrance or as one admission criterion.

Modified 30-Second Sit-to-Stand Test: Reliability and Validity in Older Adults Unable to Complete Traditional Sit-to-Stand Testing.

BACKGROUND AND PURPOSE: Sit-to-stand tests measure a clinically relevant function and are widely used in older adult populations. The modified 30-second sit-to-stand test (m30STS) overcomes the floor effect of other sit-to-stand tests observed in physically challenged older adults. The purpose of this study was to examine interrater and test-retest intrarater reliability for the m30STS for older adults. In addition, convergent validity of the m30STS, as well as responsiveness to change, was examined in older adults undergoing rehabilitation. METHODS: In phase I, 7 older adult participants were filmed performing the m30STS. The m30STS was standardized to allow hand support during the rise to and descent from standing but required participants to let go of the armrests with each stand. Ten physical therapists and physical therapist assistants independently scored the filmed m30STS twice, with 21 days separating the scoring sessions. In phase II, 33 older adults with comorbidities admitted to physical therapy services at a skilled nursing facility were administered the m30STS, Berg Balance Scale, handheld dynamometry of knee extensors, and the modified Barthel Index at initial examination and discharge. RESULTS: In phase I, the m30STS was found to be reliable. Interrater reliability using absolute agreement was calculated as intraclass correlation coefficient (ICC)2,1 = 0.737 (P ≤ .001). Test-retest intrarater reliability using absolute agreement was calculated as ICC2,k = 0.987 (P ≤ .001). In phase II, concurrent validity was established for the m30STS for the initial (Spearman ρ = 0.737, P = .01) and discharge (Spearman ρ = 0.727, P = .01) Berg Balance Scale as well as total scores of the modified Barthel Index (initial total score Spearman ρ = 0.711, P = .01; discharge total score Spearman ρ = 0.824, P = .01). The initial m30STS predicted 31.5% of the variability in the discharge Berg Balance Scale. The m30STS did not demonstrate significant correlation with body weight-adjusted strength measures of knee extensors measured by handheld dynamometry. The minimal detectable change (MDC90) was calculated to be 0.70, meaning that an increase of 1 additional repetition in the m30STS is a change beyond error. CONCLUSION: The m30STS is a reliable, feasible tool for use in a general geriatric population with a lower level of function. The m30STS demonstrated concurrent validity with the Berg Balance Scale and modified Barthel Index but not with knee extensor strength to body weight ratio. One repetition of the m30STS was established as the MDC90 as change beyond error.

Dry needling for management of pain in the upper quarter and craniofacial region.

Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.

Barriers to bicycle helmet use in young children in an urban elementary school.

PURPOSE: Traumatic brain injury is a leading cause of death in bicycle crashes. The factors associated with bicycle helmet use in young children with diverse ethnic and socioeconomic backgrounds have not been studied. The purpose of this study was to identify barriers to helmet use in young children in an urban elementary school. DESIGN: Qualitative content analysis with semistructured interviews, observational field notes, and artifacts. SETTING: Urban elementary school. PARTICIPANTS: Seventeen students whose age ranged from 5 to 7 years and whose ethnic background was identified as African American (14) or Caucasian (3). METHOD: Children participated in a brain safety fair that included presentations and activities. Semistructured, pre- and postexperience interviews were completed. Observations of the students participating in the activities and reflective art projects from the students were collected. RESULTS: The analysis found the following barriers to helmet use: (a) lack of access to a helmet, (b) poor fit of helmets due to hairstyles, and (c) lack of knowledge regarding helmet use. CONCLUSION: The present study suggests that the issue of helmet design and comfort for younger children with variable hairstyles needs to be addressed in order to increase helmet use in this population.

Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. BACKGROUND: Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points. When palpated, active myofascial trigger points cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a myofascial trigger point, with the goal of reducing pain and restoring range of motion. OBJECTIVE: To explore the evidence regarding the effectiveness of dry needling to reduce pain in patients with MPS of the upper quarter. METHODS: An electronic literature search was performed using the key word dry needling. Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trial (RCT), dry needling intervention group, and MPS involving the upper quarter. The RCTs that met these criteria were assessed and scored for internal validity using the MacDermid Quality Checklist. Four separate meta-analyses were performed: (1) dry needling compared to sham or control immediately after treatment, (2) dry needling compared to sham or control at 4 weeks, (3) dry needling compared to other treatments immediately after treatment, and (4) dry needling compared to other treatments at 4 weeks. RESULTS: The initial search yielded 246 articles. Twelve RCTs were ultimately selected. The methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range, 0-48; best possible score, 48). The findings of 3 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling. The findings of 2 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can decrease pain after 4 weeks in patients with upper-quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. CONCLUSION: Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS. Due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation. LEVEL OF EVIDENCE: Therapy, level 1a-.

Student experiences in creating and launching a student-led physical therapy pro bono clinic: a qualitative investigation.

BACKGROUND: The physical therapy profession has called for the provision of pro bono services. Little is known about the impact on students involved in sustainable pro bono leadership. One physical therapy program established a pro bono physical therapy clinic under the direct leadership of a board of students. OBJECTIVE: The purpose of this study was to describe the experiences of the inaugural members of the Chester Community Physical Therapy Clinic Student Board in creating and launching the student-led pro bono physical therapy clinic. METHODS: A purposive sample of the 18 members participated in semistructured interviews. Content analysis was conducted using a commercially available software program. Trustworthiness was enhanced with credibility, transferability, and confirmability. RESULTS: The emergent categories were: (1) leadership skill development, (2) competency in hands-on clinical and administrative skills, and (3) commitment to both the community and the clinic. Pride emerged as a strong and overarching theme throughout the experience. CONCLUSIONS: The student-led pro bono clinic meets several Commission on Accreditation in Physical Therapy Education criteria in a sustainable manner and serves as a means for measuring and meeting program mission and goals. Participation in the program was a meaningful experience and developed ownership, leadership skills, and pride among the students. There are also possibilities for expanding aspects of the program so that all physical therapist students can benefit from pro bono service opportunities.

A case report of a student-led pro bono clinic: a proposed model for meeting student and community needs in a sustainable manner.

BACKGROUND AND PURPOSE: The Chester Community Physical Therapy Clinic (clinic) is a student-led pro bono clinic that provides physical therapy services to uninsured and underinsured community members. The purposes of this administrative case report are to describe the creation and implementation of a student-led pro bono clinic model designed to meet student and community needs and to consider its potential for sustainability. CASE DESCRIPTION: Students and faculty created an organizational model with a Student Board at the center of clinic leadership. A Faculty Board provides oversight to the Student Board. State-licensed faculty and alumni provide the direct supervision of the treating student physical therapists. Evaluation of our clinic model was performed using strategies for the creation of sustainable community engagement initiatives. OUTCOMES: This model of a student-led pro bono clinic has elements of all 8 steps to sustainable community engagement. The model of a student-led pro bono clinic is feasible and sustainable. DISCUSSION: A student-led pro bono clinic serving the physical therapy needs of the uninsured and underinsured residents in an urban community presents an innovative educational and leadership development opportunity for students and alumni as well as partnership opportunities with the community.

Students mentoring students in a service-learning clinical supervision experience: an educational case report.

BACKGROUND AND PURPOSE: Service-learning projects present the opportunity to combine academic skill practice and peer mentorship with meaningful community service. Implicit learning outcomes include an enhanced understanding of social responsibility and professional development-concepts difficult to teach in the classroom. The purpose of this educational case report is to describe the development, application, and outcomes of a service-learning project designed to facilitate peer mentorship and the development of social responsibility. DEVELOPMENT OF THE PROCESS: Widener University mandated that all programs offer student community service opportunities on Martin Luther King Day. In response, the physical therapy program developed a plan to clean and screen assistive and mobility devices and provide blood pressure screening at designated community sites. APPLICATION OF THE PROCESS: All faculty and all members of the first-year and third-year Doctor of Physical Therapy (DPT) classes participated. The students and a faculty member traveled to designated community sites in teams. First-year students were able to practice newly acquired skills under the supervision and peer mentorship of third-year students. OUTCOMES: Outcomes of the service-learning project were assessed through a tally of services rendered, measurement of curricular goal achievement, a survey of the community partners' satisfaction with the event, and consideration of both first-year and third-year DPT student reflection papers. DISCUSSION: The service-learning project was effective in meeting a community need, enhancing community partner relationships, fostering student understandings of social responsibility, and creating a valuable peer mentorship experience.

Home-based leg-strengthening exercise improves function 1 year after hip fracture: a randomized controlled study.

OBJECTIVES: To compare the effectiveness of a short-term leg-strengthening exercise program with that of attentional control on improving strength, walking abilities, and function 1 year after hip fracture. DESIGN: Randomized controlled pilot study. SETTING: Patients' homes. PARTICIPANTS: Community-dwelling older adults (n=26) 6 months after hip fracture at baseline. INTERVENTION: Exercise and control participants received interventions from physical therapists twice a week for 10 weeks. The exercise group received high-intensity leg-strengthening exercises. The control group received transcutaneous electrical nerve stimulation and mental imagery. MEASUREMENTS: Isometric force production of lower extremity muscles, usual and fast gait speed, 6-minute walk (6-MW) distance, modified Physical Performance Test (mPPT), and Medical Outcomes Study 36-item Short Form Survey (SF-36) physical function. RESULTS: The primary endpoint was 1 year after fracture. Isometric force production (P=.006), usual (P=.02) and fast (P=.03) gait speed, 6-MW distance (P=.005), and mPPT score (P<.001) were improved 1 year after fracture with exercise. Effect sizes were 0.79 for strength, 0.81 for mPPT score, 0.56 for gait speed, 0.49 for 6-MW, and 0.30 for SF-36 score. More patients in the exercise group made meaningful changes in gait speed and 6-MW distance than control patients (chi-square P=.004). CONCLUSION: A 10-week home-based progressive resistance exercise program was sufficient to achieve moderate to large effects on physical performance and quality of life and may offer an alternative intervention mode for patients with hip fracture who are unable to leave home by 6 months after the fracture. The effects were maintained at 3 months after completion of the training program.

The use of health related quality of life measurement in cardiovascular and pulmonary physical therapy practice: an exploratory study.

BACKGROUND: The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends health related quality of life (HRQL) measurement with all cardiovascular and pulmonary patients. The current pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists is unknown. OBJECTIVE: The purpose of this study was to evaluate the pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists. DESIGN: The study used a semi-structured interview format within the context of 3 focus groups. METHODS: Eleven physical therapists participated in this study and all were members of the Cardiovascular and Pulmonary Section of the American Physical Therapy Association (APTA). Participants participated in a conference call and were provided a question tree to guide discussion. RESULTS: Several primary themes emerged, including decreased knowledge, barriers, and poor indicators of patient status. In addition, several subthemes developed including lack of familiarity, lack of use, administrative and cost limitations, inappropriateness of tool for patient population, correlation between function and quality of life, and suggestions for future outcome measures. CONCLUSIONS: A lack of familiarity and use of HRQL measurement and barriers to their use were established. In addition, ideas for future research on HRQL measurements with specific patient populations in physical therapy practice were defined.

Gait variability detects women in early postmenopause with low bone mineral density.

BACKGROUND: Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. OBJECTIVE: The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. DESIGN: This study was an observational cohort design with participants assigned to groups on the basis of BMD status. METHODS: Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. RESULTS: Significant between-group differences were found for step time and stance time variability. LIMITATIONS: The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. CONCLUSIONS: Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Interventions used by physical therapists in home care for people after hip fracture.

BACKGROUND AND PURPOSE: The majority of older people who survive a hip fracture have residual mobility disabilities. Any attempt to systematically reduce mobility disabilities after hip fracture, however, requires knowledge of the adequacy of current management practices. Therefore, the purpose of this study was to begin to understand the nature of physical therapy home care management by describing "usual care" for people after hip fracture. SUBJECTS AND METHODS: In 2003 and 2004, a national survey was conducted of all members of the American Physical Therapy Association who identified home care as their primary practice setting (n=3,130). "Usual care" was operationally defined as when more than 50% of respondents reported that they "always" or "often" use a specific intervention. RESULTS: Survey questionnaires (1,029) were returned with a response rate of 32.9%. Functional training activities, including bed mobility, transfer and gait training, balance training, safety training, and patient education, were reported very frequently. Active-range-of-motion exercises were performed much more frequently than exercises involving added resistance. DISCUSSION AND CONCLUSION: This study provides a detailed description of the physical therapy interventions provided in the home care setting for patients after hip fracture. The sample size and national representation increase our confidence that this description accurately depicts physical therapist practice.

Determining meaningful changes in gait speed after hip fracture.

BACKGROUND AND PURPOSE: Older subjects after hip fracture walk more slowly than age-matched peers. The extent to which they walk more slowly is difficult to define because the standard error of the measure (SEM), sensitivity to change, and clinically important change have not been reported for gait speed. The purposes of this study were to quantify the SEM for habitual and fast gait speeds among older subjects after hip fracture, to define the minimal detectable change (MDC), and to estimate the minimal clinically important difference (MCID) for habitual gait speed. SUBJECTS: A sample of 92 subjects after hip fracture was drawn from 3 studies that collected gait speed data. METHODS: An estimate of the MDC was determined by use of the SEM. The MCID was determined from expert opinion and from a receiver operating characteristic (ROC) curve. RESULTS: The SEM and the MDC were 0.08 m/s and 0.10 m/s for habitual speed and fast speed, respectively. Both methods of MCID estimation identified 0.10 m/s as a meaningful change in habitual gait speed. DISCUSSION AND CONCLUSION: The estimated MCID for gait speed of 0.10 m/s was supported by clinical expert opinion and the cutoff point of the ROC curve.

Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?

BACKGROUND AND PURPOSE: The majority of patients after a hip fracture do not return to prefracture functional status. Depression has been shown to affect recovery. Although exercise can reduce impairments, access issues limit elderly people from participating in facility-based programs. The primary purpose of this study was to determine the effects and feasibility of a home exercise program of moderate- or high-intensity exercise. A secondary purpose was to explore the relationship of depression and physical recovery. SUBJECTS: Thirty-three elderly people (24 women, 9 men; mean = 78.6 years of age, SD = 6.8, range = 64-89) who had completed a regimen of physical therapy following hip fracture participated in the study. Subjects were randomly assigned to a resistance training group, an aerobic training group, or a control group. METHODS: Subjects were tested before and upon completion of the exercise trial. Isometric lower-extremity force, 6-minute-walk distance, free gait speed, mental status, and physical function were measured. Each exercise session was supervised by a physical therapist, and subjects received 20 visits over 12 weeks. The control group received biweekly mailings. The resistance training group performed 3 sets of 8 repetitions at the 8-repetition maximum intensity using a portable progressive resistance exercise machine. The aerobic training group performed activities that increased heart rate 65% to 75% of their age-predicted maximum for 20 continuous minutes. RESULTS: Resistance and aerobic training were performed without apparent adverse effects, and adherence was 98%. All groups improved in distance walked, force produced, gait speed, and physical function. Isometric force improved to a greater extent in the intervention groups than in the control group. Depressive symptoms interacted with treatment group in explaining the outcomes of 6-minute-walk distance and gait speed. DISCUSSION AND CONCLUSION: High-intensity exercise performed in the home is feasible for people with hip fracture. Larger sample sizes may be necessary to determine whether the exercise regimen is effective in reducing impairments and improving function. Depression may play a role in the level of improvement attained.

Exercise prescription for a patient 3 months after hip fracture.

BACKGROUND AND PURPOSE: Most patients with hip fracture do not return to prefracture functional status 1 year after surgery. The literature describing interventions, however, does not use classic overload and specificity principles. The purpose of this case report is to describe the use of resistance training to improve functional outcomes in a patient following hip fracture. CASE DESCRIPTION: The patient was a 68-year-old woman who had a comminuted intertrochanteric fracture of the left hip 3 months previously. She used a cane for ambulation, and her walking was limited. The patient received 16 sessions of lower-extremity strengthening exercises, aerobic training on a stationary bicycle, functional training supervised by a physical therapist, and a home stretching program. OUTCOME: The patient's isometric muscle force for involved hip extension, hip abduction, and knee extension improved by 86%, 138%, and 33%, respectively; walking endurance increased by 22.5%; balance improved by 400%; balance confidence increased by 41%; and self-reported ability to perform lower-extremity functional activities increased by 20%. DISCUSSION: The authors believe that some patients can perform comprehensive exercise programs after hip fracture and that properly designed programs can affect patient outcomes beyond observed impairments.