COMPARATIVE EFFECTS OF CLOSED KINETIC CHAIN EXERCISES AND MOBILIZATION EXERCISES IN ELDERLY FEMALES WITH NECK OF FEMUR FRACTURE
DOI:
https://doi.org/10.71000/z6epvb78Keywords:
Exercise Therapy, Femoral Neck Fractures, Gait, Hip Joint, Pain Measurement, Postoperative Care, Range of Motion, ArticularAbstract
Background: Neck of femur fractures are among the most common hip injuries in elderly individuals, particularly postmenopausal women, due to osteoporosis and increased fall risk. These fractures significantly contribute to morbidity, functional disability, and mortality in older populations. Effective post-operative rehabilitation is crucial in restoring mobility, reducing pain, and preventing further complications in elderly females recovering from such fractures.
Objective: This study aimed to compare the effects of Closed Kinetic Chain Exercises (CKCE) and Mobilization Exercises (ME) on pain intensity, hip joint range of motion (ROM), gait performance, and fall risk in elderly females with post-operative neck of femur fractures.
Methods: A single-blinded randomized controlled trial was conducted over six months at a tertiary care hospital. A total of 49 elderly females aged ≥65 years with post-operative neck of femur fractures were initially enrolled; 44 participants completed the study. They were randomly assigned into two equal groups: Group A received Mobilization Exercises, and Group B received Closed Kinetic Chain Exercises. Both groups underwent 40-minute sessions, three times per week, for six weeks. Pain intensity, ROM, and risk of fall were assessed using the Visual Analogue Scale (VAS), goniometer, and Dynamic Gait Index (DGI), respectively. Data were analyzed using paired and independent t-tests after confirming normality with the Shapiro-Wilk test.
Results: Group B (CKCE) showed a reduction in VAS from 8.07 ± 1.35 to 2.50 ± 1.44 and an increase in DGI from 9.82 ± 2.13 to 21.45 ± 1.99. Hip ROM improved post-intervention: flexion 97.91 ± 9.12, extension 20.73 ± 3.39, abduction 33.36 ± 3.55, adduction 32.50 ± 3.39, internal rotation 31.82 ± 3.91, external rotation 33.36 ± 3.55. Group A (ME) had VAS reduced from 6.58 ± 1.70 to 4.19 ± 1.80 and DGI improved from 11.23 ± 1.90 to 19.23 ± 1.99. Post-treatment ROM for Group A included: flexion 86.27 ± 9.43, extension 14.50 ± 2.57, abduction 29.64 ± 5.05, adduction 29.45 ± 5.61, internal rotation 26.95 ± 4.85, and external rotation 29.68 ± 5.18.
Conclusion: While both interventions significantly improved outcomes, Closed Kinetic Chain Exercises were more effective in reducing pain, enhancing hip mobility, improving gait, and lowering fall risk in elderly females with post-operative neck of femur fractures.
References
Davidson A, Blum S, Harats E, Kachko E, Essa A, Efraty R, et al. Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review. International Orthopaedics. 2022;46(9):2105-15.
Schneider AM, Mucharraz C, Denyer S, Brown NM. Prolonged hospital stay after arthroplasty for geriatric femoral neck fractures is associated with increased early mortality risk after discharge. Journal of Clinical Orthopaedics and Trauma. 2022; 26:101785.
Covell AJ. Creating a Quality Improvement Toolkit to Identify & Address Gaps in the Care of Older Adults with Hip Fracture. 2020.
Zhang Y, Zhu Y, Xing X, Chen W. Research progress of fracture epidemiology. Progress in China Epidemiology: Volume 1. 2023:287-305.
Chua H, Brady B, Farrugia M, Pavlovic N, Ogul S, Hackett D, et al. Implementing early mobilisation after knee or hip arthroplasty to reduce length of stay: a quality improvement study with embedded qualitative component. BMC Musculoskeletal Disorders. 2020; 21:1-13.
Farina GR, Arrivabene NC, Delunardo AR, Rinaldi NM. Acute effect of an intervention with open and closed kinetic chain muscle strength exercises on postural control and muscle power in elderly people: A randomized clinical trial. Journal of Bodywork and Movement Therapies. 2024; 40:992-1001.
Widiastuti A, Rahmasari I, Budiati D, Ulkhasanah ME, Kartikasari AY, editors. THE EFFECT OF EARLY MOBILIZATION EXERCISE ON THE LEVEL OF INDEPENDENCE ON PATIENTS AFTER POST OPERATIVE FRACTURE FEMUR. Proceeding of International Conference on Science, Health, And Technology; 2023.
Bhurchandi S, Birelliwar A, Satone P, Chitale N, Phansopkar P, Walke R. Post-operative physiotherapy management program of inter-trochanteric fracture in an elderly patient. Journal of medical pharmaceu tical and allied sciences. 2022; 11:311-4.
Rahmasari I, Gopalan Y, Agustin T, Francisca W, Maharani M, editors. Range of Motion (ROM) Early Affecting The Ability of Activities Daily Living (ADL) Patients Post Operation Femur Fracture. Proceeding of International Conference on Science, Health, And Technology; 2021.
Zhang H, Lv J, Xu X, Mei J, Liu Y. Kinetic analysis and stability evaluation of femoral neck fracture with internal fixation based on gait rehabilitation training. Medical Engineering & Physics. 2024; 131:104222.
Srivastava T. COMPARE THE EFFECT OF MUSCLE ENERGY TECHNIQUE WITH CONVENTIONAL THERAPY VERSUS CONVENTIONAL THERAPY ALONE IN POST-OPERATIVE REHABILITATION PROGRAM IN PATIENT WITH FEMORAL NECK FRACTURE. NeuroQuantology. 2022;20(15):6609.
Özüdoğru A, Gelecek N. Effects of closed and open kinetic chain exercises on pain, muscle strength, function, and quality of life in patients with knee osteoarthritis. Revista da Associação Médica Brasileira. 2023;69(7): e20230164.
Gao Y, Zhong F, Zhan X, Bao Y, Zhu X. Postoperative rehabilitation exercise experiences of geriatric patients with femoral neck fractures based on the perspective of medical staff: a qualitative study. BMC geriatrics. 2024;24(1):667.
Overgaard JA, Kallemose T, Mangione KK, Kristensen MT. Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci. 2022;77(7):1455-62.
Milton-Cole R, O'Connell MDL, Sheehan KJ, Ayis S. The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit. Eur Geriatr Med. 2023;14(5):999-1010.
Siminiuc D, Gumuskaya O, Mitchell R, Bell J, Cameron ID, Hallen J, et al. Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study. BMC Geriatr. 2024;24(1):629.
Film R, Fritz J, Adams T, Johnson A, Sun N, Falvey J. Racial Disparities in Outpatient Physical Therapy Use After Hip Fracture: A Retrospective Cohort Study. J Orthop Sports Phys Ther. 2024;54(12):776-82.
Gao Y, Zhong F, Zhan X, Bao Y, Zhu X. Postoperative rehabilitation exercise experiences of geriatric patients with femoral neck fractures based on the perspective of medical staff: a qualitative study. BMC Geriatr. 2024;24(1):667.
Ståhl A, Westerdahl E. Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery-A Quasi-experimental Study. Clin Interv Aging. 2020;15:1821-9.
Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep. 2023;21(6):710-8.
Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2022;9(9):Cd001704.
Hulsbæk S, Bandholm T, Ban I, Foss NB, Jensen JB, Kehlet H, et al. Feasibility and preliminary effect of anabolic steroids in addition to strength training and nutritional supplement in rehabilitation of patients with hip fracture: a randomized controlled pilot trial (HIP-SAP1 trial). BMC Geriatr. 2021;21(1):323.
Che YJ, Qian Z, Chen Q, Chang R, Xie X, Hao YF. Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients. BMC Musculoskelet Disord. 2023;24(1):817.
Soukkio PK, Suikkanen SA, Aartolahti EM, Kautiainen H, Kääriä SM, Hupli MT, et al. Effects of Home-Based Physical Exercise on Days at Home, Health Care Utilization, and Functional Independence Among Patients With Hip Fractures: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2021;102(9):1692-9.
Huang MZ, Rogers MW, Pizac D, Gruber-Baldini AL, Orwig D, Hochberg MC, et al. Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial. Arch Phys Med Rehabil. 2023;104(2):169-78.
Binder EF, Bartley JM, Berry SD, Doré PM, Fisher SR, Fortinsky RH, et al. Combining Exercise Training and Testosterone Therapy in Older Women After Hip Fracture: The STEP-HI Randomized Clinical Trial. JAMA Netw Open. 2025;8(5):e2510512.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Fatima Liaquat, Gulnaz Zaheer, Sara Afzal, Khansa Muqadas, Fatima Razzaq, Rimsha Arshad, Momina Akram, Kiran Samdani (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.