• Catherine Sherrington, Nicola Fairhall, Catherine Kirkham, Lindy Clemson, Anne Tiedemann, Constance Vogler, CloseJacqueline C TJCTPrince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia.Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia., Sandra O'Rourke, Anne M Moseley, Ian D Cameron, MakJenson C SJCSJohn Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, Australia.Rehabilitation and Aged Care Services, Gosford Hospital, Gosford, NSW, Australia., and Stephen R Lord.
• Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, NSW, Australia. cathie.sherrington@sydney.edu.au.
• J Gen Intern Med. 2020 Oct 1; 35 (10): 2907-2916.

BackgroundDisability and falls are common following fall-related lower limb and pelvic fractures.ObjectiveTo evaluate the impact of an exercise self-management intervention on mobility-related disability and falls after lower limb or pelvic fracture.DesignRandomized controlled trial.ParticipantsThree hundred thirty-six community dwellers aged 60+ years within 2 years of lower limb or pelvic fracture recruited from hospitals and community advertising.InterventionsRESTORE (Recovery Exercises and STepping On afteR fracturE) intervention (individualized, physiotherapist-prescribed home program of weight-bearing balance and strength exercises, fall prevention advice) versus usual care.Main MeasuresPrimary outcomes were mobility-related disability and rate of falls.Key ResultsPrimary outcomes were available for 80% of randomized participants. There were no significant between-group differences in mobility-related disability at 12 months measured by (a) Short Physical Performance Battery (continuous version, baseline-adjusted between-group difference 0.08, 95% CI - 0.01 to 0.17, p = 0.08, n = 273); (b) Activity Measure Post Acute Care score (0.18, 95% CI - 2.89 to 3.26, p = 0.91, n = 270); (c) Late Life Disability Instrument (1.37, 95% CI - 2.56 to 5.32, p = 0.49, n = 273); or in rate of falls over the 12-month study period (incidence rate ratio 0.96, 95% CI 0.69 to 1.34, n = 336, p = 0.83). Between-group differences favoring the intervention group were evident in some secondary outcomes: balance and mobility, fall risk (Physiological Profile Assessment tool), physical activity, mood, health and community outings, but these should be interpreted with caution due to risk of chance findings from multiple analyses.ConclusionsNo statistically significant intervention impacts on mobility-related disability and falls were detected, but benefits were seen for secondary measures of balance and mobility, fall risk, physical activity, mood, health, and community outings.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12610000805077.

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