Progressive Strength Training for Pain Management, Functional Strength Gains, and Reduced Fall Risk in an Elderly Patient Immediately Following Hip Fracture Repair: A Case Study.

Abstract

Background and Purpose:  Hip fractures in elderly patients are associated with poor functional recovery, high levels of post surgical pain, and increased fall risk during the initial stages of rehabilitation. Prior research has attempted to determine optimal treatment approaches; however no best intervention plan has been identified. This case study demonstrates an effective progressive strengthening program that placed focus on pain management, while attempting to strengthen lower extremity muscles to improve function in an older adult patient following a hip fracture.  Case Description: The patient was an 80-year old male admitted to an inpatient rehabilitation hospital following hip fracture repair on his right lower extremity. He possessed high levels of post-operative pain that significantly limited his ability to participate in functional activities. Upon admission, functional outcome measures including the Berg Balance Scale (BERG) and Functional Independence Measure (FIM) were evaluated to be 64/126 and 6/56 respectively, both values in the range associated with high risk for poor outcomes. The patient was seen daily over the course of a three-week hospital stay and treatment consisted of an individualized progressive exercise program designed to improve his function and manage his pain. Outcomes: The patient demonstrated clinically detectable improvements on both the BERG balance scale as well FIM following a three-week intervention period with the exercise program being investigated. Furthermore, the patient reported decreased levels of pain and improved perceptions of overall independence upon discharge.  Clinical Relevance: The outcomes shown in this case indicate that this particular progressive exercise protocol may be beneficial in treating patients recovering from hip fracture repair who additionally exhibit high levels of pain. Future research is needed to determine best possible implementation of specific exercises, as well as program outcomes on a larger patient population.