Stair Ascent & Descent
- Move feet backwards
- Lean forward at trunk with spine extended
- Move knees foward
- Extend hips and knees
- Elbow extension
- Hip & knee extension from deep squat
- Turning within a small radius with a narrow base
- Hip & knee flexion to step over tub wall
Ability to weight shift from one extremity to the other
- Controlled knee flexion after heel strike
- Hip extension through-out
- Hip and Knee Extension
- Ankle DF
- Forward shift of trunk
- Lean forward at trunk with spine extended
- Move knees forward
- Flex knees
- Hip and knee flexion
- Turning within a small radius
- Deep Squat with significant hip & knee flexion
- Controlled elbow flexion
Ability to handle postural disturbances (i.e. dual task situations)
- Knee flexion & hip flexion
- Knee extension at heel strike with ankle DF
- Controlled hip and knee flexion
- Maintain trunk over supporting leg
Agency for Health Care Policy and Research. (1999). Hospital Inpatient Statistics, 1996. Washington, DC: US Department of Health and Human Services (AHCPR publication 99-0034).
Alexander NB, Galecki AT, Grenier ML, Nyquist LV, Hofmeyer MR & Grunawalt JC. (2001). Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair. Journal of the American Geriatric Society, 49(11), 1418-1427.
Bean JF, Herman S, Kiely DK, Frey IC, Leveille SG & Fielding RA. (2004). Increased Velocity Exercise Specific to Task (InVEST) training: A pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women. Journal of the American Geriatric Society, 52(5), 799-804.
Binder E, Schechtman K, Ehsani A, Steger-May K, Brown M, Sinacore D, Yarasheski K. & Holloszy J. (2002). Effects of exercise training on frailty in community dwelling older adults: Results of a randomized, controlled trial. Journal of the American Geriatric Society, 50, 1921-1928.
Binder EF, Brown M, Sinacore DR, Steger-May K, Yarasheski KE & Schechtman KB. (2004). Effects of extended outpatient rehabilitation after hip fracture: A randomized controlled trial. Journal of the American Medical Association, 292(7), 837-846.
Carmeli E, Sheklow SL, & Coleman R. (2006). A comparative study of organized class based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery. Disability and Rehabilitation, 28(16), 997-1005.
Carr JH, & Shepherd RB. (1987). A motor relearning programme for stroke London: Butterworth-Heinemann Physiotherapy.
Cauley JA, Thompson DE, Ensrud KC, Scott JC & Black D. (2000). Risk of mortality following clinical fractures. Osteoporosis International, 11(7), 556-561.
Chan DY, Chan CC, & Au DK. (2006). Motor relearning programme for stroke patients: a randomized controlled trial. Clinical Rehabilitation, 20(3), 191-200.
Chudyk, AM, Jutai JW, Petrella RJ & Speechley M. (2009). Systematic review of hip fracture rehabilitation practices in the elderly. Archives of Physical Medicine and Rehabilitation, 90, 249-253.
de Jong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H. (2005). Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction? Clinical Journal of Pain, 21(1), 9-17.
de Vreede PL, Samson MM, van Meeteren NL, Duursma SA, & Verhaar HJ. (2005). Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. Journal of the American Geriatrics Society, 53(1), 2-10.
Distefano LJ, Clark MA & Padua DA. (2009). Evidence Supporting Balance Training in Healthy Individuals: A Brief Review. Journal of Strength Conditioning Research. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19910803?itool
Fillenbaum GG & Smyer MA (1981). The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. Journal of Gerontology, 36(4), 428-434.
George SZ, Zeppieri G. Jr., Cere AL, Cere MR, Borut MS, Hodges MJ, Reed DM, Valencia C, Robinson ME. (2008). A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain. Pain, 140(1), 145-157.
Gruber-Baldini A, Zimmerman S, Morrison R, Grattan L, Dolan M & Hebel J. (2003). Cognitive impairment in hip fracture patients: Timing of detection and longitudinal follow-up. Journal of the American Geriatrics Society, 51(9), 1227-1236.
Haentjens P, Autier P, Bärette M & Boonen S. (2001). The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis Belgian Hip Fracture Study Group. Journal of Bone and Joint Surgery 83-A(4), 493-500.
Hauer K, Specht N, Schuler M, Brtsch P & Oster P. (2002). Intensive physical training in geriatric patients after severe falls and hip surgery. Age & Ageing, 31(1), 49-57.
Hofmeyer MR, Alexander NB, Nyquist LV, Medell JL & Koreishi A. (2002). Floor-rise strategy training in older adults. Journal of the American Geriatrics Society, 50(10), 1702-1706.
Jette AM. (1980). Functional Status Index: Reliability of a chronic disease evaluation instrument. Archives of Physical Medicine and Rehabilitation, 61(September), 395-401.
Jette AM, Branch LG & Berlin J. (1990). Musculoskeletal impairments and physical disablement among the aged. Journal of Gerontology: Medical Sciences, 45(6), M203-M208.
Johnson MF, Kramer AM, Lin MK, Kowalsky JC & Steiner JF. (2000). Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke. Journal of the American Geriatrics Society, 48(11), 1389-1397.
Jones GR, Jakobi JM, Taylor AW, Petrella RJ, & Vandervoort AA. (2006). Community exercise program for older adults recovering from hip fracture: A pilot study. Journal of Aging and Physical Activity, 14, 439-455.
Krebs DE, Scarborough DM, & McGibbon CA. (2007). Functional vs. strength training in disabled elderly outpatients. American Journal of Physical Medicine and Rehabilitation, 86(2), 93-103.
Lawton MP & Brody EM. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179-186.
Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M. (2000). Recovery from hip fracture in eight areas of function. Journal of Gerontology: Medical Sciences, 55A(9), M498-M507.
Magaziner J, Simonsick EM, Kashner TM, Hebel JR & Kenzora JE. (1990). Predictors of functional recovery one year following hospital discharge for hip fracture: A prospective study. Journal of Gerontology: Medical Sciences, 45(3), M101-M107.
Mahoney F & Barthel D. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14(2), 61-66.
Mangione KK, Craik KL, Tomlinson SS & Palombaro KM. (2005). Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home? Physical Therapy 85(8), 727-739.
Manini TM, Clark BC, Tracy BL, Burke J, & Ploutz-Snyder L. (2005). Resistance and functional training reduces knee extensor position fluctuations in functionally limited older adults. European Journal of Applied Physiology, 95(5-6), 436-446.
Nagi, S. (1976). An epidemiology of disability among adults in the United States. Milbank Memorial Fund Quality Health Soc., 54, 439-467.
Peterson MGE, Ganz SB, Allegrante JP & Cornell CN. (2004). High intensity exercise training following hip fracture, Topics in Geriatric Rehabilitation, 20(4), 273-284.
Resnick B, Orwig D, Inguito P, & Xi BB. (2007). The Baltimore Hip Studies Projects: Prevention of Fracture Through Intervention. Symposium. Gerontological Society of America. The Gerontologist, 47(1), 203.
Resnick B, Orwig D, Yu-Yahiro J, Hawkes W, Shardell M, Hebel JR & Magaziner J. (2007). Testing the Effectiveness of the Exercise Plus Program in Older Women Post-Hip Fracture. Annals of Behavioral Medicine, 34(1), 67-76.
Resnick B, Orwig D, Zimmerman S, Simpson M, & Magaziner J. (2005). The Exercise Plus Program for Older Women Post Hip Fracture: Participant Perspectives. The Gerontologist, 45(4), 539-544.
Rose S & Maffulli N. (1999). Hip fractures: an epidemiological review. Bulletin Hospital Joint Disease, 58(4), 197-201.
Shaw WS, Linton SJ & Pransky G. (2006). Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors? Journal of Occupational Rehabilitation, 16(4), 591-605.
Sherrington C & Lord SR. (1997). Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 78(2), 208-212.
Sherrington C, Lord SR & Finch CF. (2004). Physical activity interventions to prevent falls among older people: update of the evidence. Journal of Science Medicine and Sport, 7(1Supp), 43-51.
Sherrington C, Lord SR & Herbert RD. (2003). A randomized trial of weight-bearing versus non-weight-bearing exercise for improving physical ability in inpatients after hip fracture. Australian Journal of Physiotherapy, 49(1), 15-22.
Sherrington C, Lord SR. & Herbert RD. (2004). A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Archives of Physical Medicine and Rehabilitation, 85(5), 710-716.
Tinetti ME, Baker D, Gallo WT, Nanda A, Charpentier P & O'Leary J. (2002). Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care. Journal of the American Medical Association, 287(16), 2098-2105.
Trudelle-Jackson E & Smith S. (2004). Effects of a late-phase exercise program after total hip arthroplasty: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85(7), 1056-1062.
Tsauo J, Leu W, Chen Y & Yang R. (2005). Effects on function and quality of life of postoperative home-based physical therapy for patients with hip fracture. Archives of Physical Medicine and Rehabilitation, 86(10), 1953-1957.
Van Balen R, Steyerberg E, Polder J, Ribbers T, Habbema J & Cools HJ. (2001). Hip fracture in elderly patients: outcomes for function, quality of life and type of residence. Clinical Orthopedics, 390, 232-243.
Verbrugge LM & Jette AM. (1994). The disablement process.Social Science Medicine,38(1), 1-14.
Vlaeyen JW, de Jong J, Geilen M, Heuts PH, & van Breukelen G. (2002). The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clinical Journal of Pain, 18(4), 251-261.
Yu-Yahiro J, Resnick B, Orwig D, Hicks GE, Magaziner J. (2009) Design and Implementation of a Home-Based Exercise Program Post-Hip Fracture: The Baltimore Hip Studies Experience. Physical Medicine & Rehabilitation, 1(4), 308-318.
Support for this project was provided by National Institute on Aging (NIA) grants R37 AG09901, R01-AG18668, R01 AG17082, and the Claude D. Pepper Older Americans Independence Center P60-AG12583. Authors also would like to thank Thera-Band Academy for their generous contribution of Thera-Band¨ resistive bands used by study participants; hospitals and personnel participating in the Baltimore Hip Studies; and research staff who worked with study patients and their families.
Authors would also like to thank hip fracture patients and their families for volunteering their time and information for this work.
Corresponding Author: Barbara Resnick, PhD, CRNP, FAAN, FAANP
Sonya Ziporkin Gershowitz, Chair in Gerontology, Professor, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201
Gregory E. Hicks, PT, PhD, University of Delaware
Denise Orwig, PhD, University of Maryland School of Medicine, Dept of Epidemiology, Redwood Street, Baltimore, MD 21201
Janet Yu-Yahiro, Union Memorial Orthopaedics, The Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21211
Jay Magaziner, PhD, University of Maryland School of Medicine, Dept of Epidemiology, Redwood Street, Baltimore, MD 21201
International Journal of Disability, Community &
Volume 9, No. 1