Effects of a simple home exercise program and vitamin D supplementation on health-related quality of life after a hip fracture: a randomized controlled trial

Authors: RENERTS, KLAVS - University Of Zurich; FISCHER, KARINA - University Of Zurich; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; ORAV, ENDEL - Harvard University; FREYSTAETTER, GREGORY - University Of Zurich; SIMMEN, HANS-PETER - University Hospital Zurich; PAPE, HANS CHRISTOPH - University Hospital Zurich; EGLI, ANDREAS - University Hospital Zurich; THEILER, ROBERT - University Of Zurich; BISCHOFF-FERRARI, HEIKE - University Of Zurich

Submitted to: Quality of Life Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/3/2019
Publication Date: 2/9/2019
Citation: Renerts, K., Fischer, K., Dawson-Hughes, B., Orav, E.J., Freystaetter, G., Simmen, H., Pape, H., Egli, A., Theiler, R., Bischoff-Ferrari, H. 2019. Effects of a simple home exercise program and vitamin D supplementation on health-related quality of life after a hip fracture: a randomized controlled trial. Quality of Life Research. 28(5):1377-1386. https://doi.org/10.1007/s11136-019-02100-4.
DOI: https://doi.org/10.1007/s11136-019-02100-4

Interpretive Summary: Well-tolerated interventions that improve the quality of life are urgently needed to be broadly implemented among the rising number of seniors with hip fractures. This study was done to assess the effects of vitamin D supplementation and a simple home exercise program on health-related quality of life (HRQL) in the first 12 months after a hip fracture. We enrolled 173 patients with a recent hip fracture into this 12 month study. HRQL was assessed at baseline (on average 4 days post-surgery) and at 6 and 12 months after hip fracture surgery. The effects of vitamin D (2000 vs. 800 IU vitamin D3 per day) and home exercise or no exercise on HRQL were assessed. HRQL significantly worsened from 0.71 pre-fracture to 0.57 over 12 months, but did not differ between individual or combined interventions. However, regarding only the late recovery between 6 to 12 months, the group receiving the lower dose of 800 IU/day of vitamin D and no home exercise experienced a significant further decline in their HRQL while the other groups remained stable. These findings indicate that hip fractures have a negative effect on quality of life for up to 12 months after the fracture. However, home exercise and/or 2000 IU vitamin D per day may help prevent a further decline in HRQL after the first 6 months following the acute hip fracture event.

Technical Abstract: Purpose: To test the effects of vitamin D intervention and a simple home exercise program (HE) on health-related quality of life (HRQL) in the first 12 months after hip fracture. Methods: HRQL was reported in 173 acute hip fracture patients (mean age 84 years, 79% females, 77% community dwelling) who were enrolled in the 12-month 2 x 2 factorial Zurich Hip Fracture Trial. Pre-fracture HRQL was assessed at baseline (4.2 +/- 2.2 days post-surgery) and then again at 6 and 12 months after hip fracture surgery by the EuroQol EQ-5D-3L index value (EQ-5D-3L questionnaire). The effects of vitamin D intervention (2000 vs. 800 IU vitamin D3) and exercise (HE vs. no HE) or of the combined interventions on HRQL were assessed using multivariable-adjusted repeated-measures linear mixed-effects regression models. Results: The EQ-5D-3L index value significantly worsened from 0.71 pre-fracture to 0.57 over 12 months, but the degree of worsening did not differ between individual or combined interventions. However, regarding only the late recovery between 6 and 12 months, the group receiving neither intervention (800 IU/day and no HE) experienced a significant further decline in the EQ-5D-3L index value (adjusted mean change = 0.08 [95% CI 0.009, 0.15], p = 0.03) while all other groups remained stable. Conclusion: Hip fractures have a long-lasting negative effect on HRQL up to 12 months after hip fracture. However, HE and/or 2000 IU vitamin D per day may help prevent a further decline in HRQL after the first 6 months following the acute hip fracture event.