Authors (including presenting author) :
Wu AYT, Lee JWK, Wong TFY, Lee SKF, Woo CW, Leung KLK
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Conventional physiotherapy intervention for hip fracture patients tends to focus on regaining lower limb range of motion, muscle strength, pain relief and improving balance ability, while upper limb functions are less prioritized. Yet, studies have demonstrated that most upper limb functions are impaired(1) in hip fracture patients and handgrip strength is one of the predictors of positive functional outcome post-fracture(2).
Objectives :
To highlight the significance of upper limb training in hip fracture patients by incorporating upper limb training with smart indicator.
Methodology :
Twelve hip fracture patients were included in this study. Various upper limb training was incorporated in addition to conventional physiotherapy treatments. It involved upper extremity strengthening exercises, agility, reaction time and functional training using Witty SEM by Microgate, a smart indicator composed of LED matrix that displays different symbols and colours for reactivity, agility and cognitive-motor training. Discriminative response tasks were also chosen to challenge patients’ visual discrimination, attention and upper limb reactivity skills. Patients’ functional outcome was evaluated before and after the treatment programme using objective outcome measurements including Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS), Numeric Pain Rating Scale (NPRS), handgrip strength (HGS), upper limb reaction time and Jebsen-Taylor Hand Function Test (JTHFT) Subtest 6 and 7.
Result & Outcome :
Twelve patients aged 72-98 completed this training program inside a period of 26-70 days of rehabilitation without any adverse incident reported. Statistically significant improvement was demonstrated in MFAC (t=5.000, p=0.000), EMS (t=6.167, p<0.001), NPRS (t=-10.352, p<0.001), HGS (t=4.451, p<0.001), JTHFT subtest 6 for dominant hand (t=-6.171, p<0.001) and non-dominant hand (t=-4.523, p=0.001), JTHFT subtest 7 for dominant hand (t=-6.792, p<0.001) and nondominant hand (t=-7.529, p<0.001), and upper limb reaction time (t=-5.451, p<0.001). Furthermore, a significant negative and moderately strong correlation (r=-0.768, p=0.004) between patient’s age and HGS improvement was displayed, reflecting that younger elderly may have greater upper limb functional improvement. Additionally, moderately strong and positive correlations in patient’s improvement in MFAC (ρ=0.770, p=0.003) and EMS (r=0.636, p=0.026) comparing with HGS were also found. These results showed that enhancing upper limb function into conventional physiotherapy training program were both safe and effective in improving hip fracture patients’ hand motor function and overall functional mobility.
