The Effect of Intensive Abductor Strengthening on Postoperative Muscle Efficiency and Functional Ability of Hip-Fractured Patients: A Randomized Controlled Trial

BACKGROUND: Hip fractures are common in the elderly and many patients fail to regain prefracture hip abductor strength or functional status. The purpose of this clinical trial was to compare the effects of an intensive abductor muscle exercise program versus a standard physiotherapy intervention in hip-fractured patients. MATERIALS AND METHODS: Ninety six femoral neck-fractured patients were randomized into equal-sized groups. A 12-week standard physiotherapy program was implemented in the control group(S-PT) whereas an intensive exercise program, emphasizing on abductors’ strengthening, was implemented in the research group(I-PT). Abductors’ isometric strength of the fractured hip, abductor ratio% in the fractured compared to contralateral hip, and functional level were assessed at the 3(rd) (postintervention) and 6(th) (followup) months. RESULTS: Postintervention, abductors’ isometric strength was 35.7% greater (P < 0.0005) and abductor ratio% was 2.5% higher (P < 0.0005) in I-PT group, compared to S-PT group. With regard to functional assessments, I-PT group was 29.1% faster during Timed Up and Go (TUG) test and achieved a 26.7% higher Lower Extremity Functional Scale Greek version's (LEFS-Greek) total score, compared to S-PT group (P < 0.0005). At followup, abductors’ isometric strength was 37.0% greater (P < 0.0005) and abductor ratio% was 7.1% higher (P < 0.0005) in I-PT group, compared to S-PT group. In addition, I-PT group was 45.9% faster during TUG test (P < 0.0005) and achieved an 11.2% higher LEFS-Greek total score, compared to S-PT group (P = 0.013). CONCLUSIONS: Compared to the standard physiotherapy intervention, the intensive abductor-strengthening program significantly increased both abductors’ isometric strength of the fractured hip and abductor ratio% and resulted in patients’ enhanced functional level. CLINICAL TRIAL IDENTIFIER: ISRCTN30713542.