Effectiveness of a physical therapist-directed home exercise program in elderly patients post-hip fracture surgery in a low-resource setting: A retrospective cohort study

Abstract

OBJECTIVE: To evaluate the effectiveness of a four-week physical therapist-directed home exercise program versus usual care in elderly patients after hip fracture surgery. METHODS: This retrospective cohort study was conducted in Thailand (July 2022-May2023) among 30 patients aged 60-90 years who underwent hip fracture surgery. Participants were assigned based on residence to a home exercise group (n = 15), receiving biweekly home visits from physical therapists, or a usual care group (n = 15), receiving exercise leaflets. Functional outcomes-Short Physical Performance Battery (SPPB), 2-Minute Walk Test (2MWT), Modified Functional Ambulation Category (FAC), and Katz Activities of Daily Living (ADL) Index-were assessed at discharge and after four weeks. RESULTS: Both groups improved significantly on all outcomes (p < 0.05). The home exercise group showed greater median improvement in SPPB scores than usual care (3 points; 95 % CI: 1.1-4.9; p = 0.002), surpassing the minimal clinically important difference. No significant differences were observed for 2MWT, FAC, or Katz ADL. Adherence to the home program was moderate (62.5 %), with higher adherence linked to greater SPPB gains. CONCLUSIONS: A four-week therapist-directed home exercise program is feasible and more effective than usual care in improving lower extremity function in elderly post-hip fracture patients. This approach is a viable option in resource-limited settings to enhance early recovery.