Randomized controlled trial of quadriceps training after proximal femoral fracture

Objective: To determine whether systematic progressive high-intensity quadriceps training increases leg extensor power and reduces disability in patients rehabilitating after proximal femoral fracture. Design: Open parallel group randomized controlled trial comparing the addition of six weeks quadriceps training (40 patients) with standard physiotherapy alone (40 patients). The training group exercised twice weekly, with six sets of 12 repetitions of knee extension (both legs), progressing up to 80% of their one-repetition maximum. Setting: Orthogeriatric unit, and community follow-up. Subjects: Eighty patients rehabilitating after proximal femoral fracture. Main outcome measures: Measurements of leg extensor power (Nottingham Power Rig), functional mobility (elderly mobility score), disability (Barthel Index) and quality of life (Nottingham Health Profile) were made at baseline, after six weeks (at the end of the intervention) and at 16 weeks. Results: Leg extensor power increased significantly in the quadriceps training group (fractured leg mean improvement at six weeks 157% (standard error 16), nonfractured leg 80% (12)) compared with the control group (63% (11) and 26% (8) respectively, unpaired Student's t-test p = 0.007 and p = 0.01 for between-group comparisons). Significant benefits were maintained at 16 weeks. Quadriceps training resulted in a greater increase in elderly mobility scale score compared with standard rehabilitation (between-group difference of 2.5 (95% CI 1.1,3.8) at week 6 and 1.9 (0.4,3.4) at week 16). Barthel score increased significantly from week 0 to 6 in the quadriceps training group compared with controls (Mann-Whitney U-test p = 0.05). Patients in the quadriceps training group scored significantly better in the energy subscore of the Nottingham Health Profile at the end of follow-up (Mann-Whitney U-test p = 0.0185). Conclusions: Progressive high-intensity quadriceps training in elderly proximal femoral fracture patients increased leg extensor power and reduced disability. This was accompanied by an increase in energy as measured by the Nottingham Health Profile. This intervention may provide a simple practical way of improving outcome in these patients.