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Physician Update – November 2022

PT Surpasses ‘Usual Care’

The Most Effective Way to Rehabilitate Patients After a Fall

Every 13 seconds, an older adult is rushed to the emergency room for help with a fall-related injury. According to the National Council on Aging, many of these people don’t survive. A senior dies from a fall approximately every 20 minutes in the United States. Those who do make it face a long road to recovery from fall-related injuries like broken bones and head trauma — and they may end up in your office.

There are several approaches to rehabilitation after a fall, including geriatrician-led care at a fall prevention clinic, physical therapy, home exercise, and more. All of these methods are aimed at improving the patient’s strength, balance, and confidence to reduce their fall risk in the future. Physicians may prescribe a combination of these treatments — but they’re not created equal.

A recent randomized controlled trial compared the effectiveness of geriatrician-led care at a fall prevention clinic (considered “usual care” by researchers) with a combination of usual care and a home-based strength and balance retraining exercise program delivered by a physical therapist. The yearlong trial included 344 patients divided at random into two groups. One hundred and seventy two patients received usual care, and 173 received usual care and the home exercise program.

Researchers followed up with these patients roughly a year after the trial to discover how
effective each option was at preventing successive falls. Their results were impressive:
Patients who received usual care fell an average of 2.1 times in the year following
rehabilitation, while those who received usual care and the PT-delivered home exercise program fell just 1.4 times on average. As the authors put it, “Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician.

This wasn’t the first study to underscore the importance of physical therapy in a patient’s post-fall rehabilitation. Years earlier, researchers at the Washington University School of Medicine conducted a randomized controlled trial of 90 patients ages 65 and up. All of the
patients had previously suffered hip fractures (a common fall injury) and undergone surgery and standard physical therapy. The trial compared the effectiveness of physical therapy and home exercise to see which method improved patient function and reduced disability the most. It found that PT was the more effective form of extended outpatient rehabilitation, leading to higher scores on a modified Physical Performance Test and the Functional Status Questionnaire physical function subscale, and further improved muscle strength, walking speed, balance, and perceived health.

Physical therapists use a range of techniques to help patients regain their strength after a fall, often including mobilization, gait training, balance training, weight-shifting exercises, and strength training exercises targeted at the hip flexors, extensors, abductors, and core. These techniques are a key part of outpatient care, and PT has also been shown to “confer significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength” to patients still in the intensive care unit (ICU).

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Julian Manrique

Focus Physical Therapy

"We Help Adults Get Back To Their Normal Active Lifestyles Naturally...While Avoiding Medications, Injections, And Surgeries"