Effect of extended physiotherapy and high-dose vitamin D on rate of falls and hospital re-admission after acute hip fracture: a randomized controlled trial

Authors: BISCHOFF-FERRARI, HEIKE - University Hospital Zurich; Dawson-Hughes, Bess; PLATZ, ANDREAS - Triemli Hospital; ORAV, JOHN - Brigham & Women'S Hospital; STAEHELIN, HANNES - University Hospital Of Basel; WILLETT, WALTER - Harvard School Of Public Health; CAN, UENAL - Triemli Hospital; EGLI, ANDREAS - University Hospital Of Basel; MUELLER, N - Universitat Graz; LOOSER, SILVAN - University Hospital Of Basel; BRETSCHER, BEAT - Triemli Hospital; MINDER, E - Triemli Hospital; MICHEL, BEAT - University Hospital Zurich; VERGOPOULOS, A - Institute Of Medical Immunology; THEILER, ROBERT - Triemli Hospital

Submitted to: Archives of Internal Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/3/2010
Publication Date: 5/10/2010
Citation: Bischoff-Ferrari, H.A., Dawson-Hughes, B., Platz, A., Orav, J.E., Staehelin, H.B., Willett, W.C., Can, U., Egli, A., Mueller, N., Looser, S., Bretscher, B., Minder, E., Michel, B.A., Vergopoulos, A., Theiler, R. 2010. Effect of extended physiotherapy and high-dose vitamin D on rate of falls and hospital re-admission after acute hip fracture: a randomized controlled trial. Archives of Internal Medicine. 7:26-34.

Interpretive Summary: Supplemental vitamin D at a dose of 700-800 IU per day has been shown to reduce risk of falls in community-dwelling older individuals. Several studies of frail older individuals have found a reduction of falls with exercise, even if applied as an unsupervised home program. The goal of this randomized controlled trial was to determine the additive benefit of extended physiotherapy and 2000 IU of vitamin D per day on the rate of falls and hospital re-admission in the first 12 month after acute hip fracture. One hundred and seventy three individuals participated in the trial (79% women; mean age 84 years; 77% living in the community) and 212 falls were documented. Supplemental vitamin D significantly reduced the number of injurious falls and the number of hospitalizations and extended physiotherapy significantly reduced the number of falls. We conclude that extended physiotherapy and supplemental vitamin D have complementary benefits in preventing falls and hospital readmissions in older men and women with recent hip fractures.

Technical Abstract: Guidelines for post-fracture care of elderly hip fracture patients are not established despite the significant socio-economic burden of post hip fracture morbidity and mortality. Using a factorial design, we studied the effects of extended physiotherapy (supervised 1 hour per day during acute care plus unsupervised home program; extended PT) compared to standard physiotherapy (supervised 30 minutes per day during acute care and no home program), as well as the effects of 2000 IU versus 800 IU vitamin D3 per day, on the rate of falls and hospital re-admission. Physiotherapy was single-blinded and vitamin D dose double-blinded. Over the 12 month follow-up, outcomes were compared between treatment arms of both strategies using multivariate Poisson regression analyses. The trial enrolled 173 acute hip fracture patients (79% women; mean age 84 years; 77% living in the community). Serum 25-hydroxyvitamin D was below 30 nmol/l in 51% of patients. We documented 212 falls with a rate of 1.43 falls per observed patient-year and 74 hospital re-admissions with a rate of 0.5 per observed patient-year. Extended PT reduced the rate of falls significantly by 25% (95% CI: -44%,-1%) over 12 months follow-up. 2000 IU versus 800 IU vitamin D per day reduced the rate of hospital re-admission significantly by 39% (95% CI: -62%, -1%). Extended PT and supplementation with 2000 IU vitamin D per day have complementary benefits on rate of falls and hospital re-admission after acute hip fracture. Both appear to be beneficial in optimizing post-hip-fracture care.