{"paper_id":"43b3b944-e39f-443f-90fc-717403fd9db2","body_text":"Feasibility and Efficacy of Real-time Teleresistance Exercise Programs for Physical Function in Elderly Patients After Hip Fracture Surgery: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility and Efficacy of Real-time Teleresistance Exercise Programs for Physical Function in Elderly Patients After Hip Fracture Surgery: A Randomized Controlled Trial Piyapat Dajpratham, Jidapa Komas, Rungsima Yamthed, Prasertphon Chanthon, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5382513/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Aug, 2025 Read the published version in BMC Geriatrics → Version 1 posted 14 You are reading this latest preprint version Abstract Background Hip fractures substantially impair quality of life and functional outcomes in elderly individuals. With incidence rates rising globally and in Thailand, effective rehabilitation strategies are crucial. This study evaluated the feasibility and efficacy of teleresistance exercise programs compared with traditional exercise booklets in elderly patients following hip fracture surgery. Methods A single-blind, randomized controlled trial was conducted. Elderly patients aged 60 to 90 years who had undergone hip fracture surgery were randomized into two groups. The intervention group received a 12-week teleresistance exercise program, whereas the control group followed an exercise booklet. The primary outcome was the short physical performance battery (SPPB). The secondary outcomes were the two-minute walk test (2MWT) score, knee extension strength, and anxiety level. Results Thirty-three participants with a mean age of 76.8 years (SD 8.6) were enrolled. At 12 weeks, the intervention group presented significant improvements in SPPB scores compared with those of the control group (P = 0.040). There were no significant differences in 2MWT, knee extension strength or anxiety scores between the groups. The improvements in SPPB and 2MWT scores for the intervention group surpassed the minimal clinically important difference. Conclusions Compared with traditional exercise booklets, teleresistance exercise programs significantly enhance physical function in elderly patients following hip fracture surgery. This method offers a feasible and effective alternative to standard rehabilitation approaches. Future research should explore long-term effects and refine exercise protocols for telerehabilitation. Trial registration: Thai Clinical Trials Registry (TCTR20220123001/ 2022-01-21) Elderly Exercise Therapy Hip Fractures Physical Function Telemedicine Teleresistance Exericse Figures Figure 1 Figure 2 Introduction Hip fractures are major public health issues that significantly affect patients’ quality of life, functional ability, 1 and overall health. They also impose substantial costs on healthcare systems. 2 The incidence of hip fractures varies widely worldwide. Between 2005 and 2018, rates ranged from 95.1 per 100 000 in Brazil to 315.9 per 100 000 in Denmark. As the population ages, the number of hip fractures is expected to double by 2050, impacting both men and women. The incidence sharply increases with age. 3 In Thailand, osteoporotic hip fractures are a growing concern. Crude incidence rates rose from 112.7 per 100 000 in 2013 to 146.9 per 100 000 in 2022. During the same period, annual hospitalization costs surged from 17.3 million USD to 42.8 million USD. 4 The median one-year mortality rate after hip fracture is 22.8%. 3 Survivors often experience marked declines in mobility, independence, and health-related quality of life. 5 Between 33% and 69% struggle to return to prefracture daily activities, and 20–66% cannot regain their previous mobility within 6 months. 6 , 7 Rehabilitation is essential for restoring independence, 8 with evidence supporting the effectiveness of multidisciplinary inpatient rehabilitation. 9 Both outpatient and home-based rehabilitation have proven beneficial. 10 Systematic reviews indicate that home-based approaches can match inpatient options for appropriate patients. 11 , 12 Notably, progressive resistance exercises can significantly improve mobility, daily activities, balance, and strength. 7 , 9 , 13 In Thailand, barriers to accessing rehabilitation include limited healthcare resources, socioeconomic challenges, travel difficulties, and the impact of the COVID-19 pandemic. These factors have hindered continuous rehabilitation efforts. Telerehabilitation has emerged as a promising solution to these challenges. Previous studies have indicated that telerehabilitation is feasible, safe, and effective for home-based rehabilitation in older adults following hip fractures. 14 However, most existing research has focused on asynchronous telerehabilitation methods, 15 which lack real-time coaching and feedback. Given the aging population and rising incidence of hip fractures in Thailand, this study aimed to evaluate the feasibility and effectiveness of real-time telerehabilitation resistance exercise programs compared with traditional rehabilitation methods in terms of physical function. Methods Study Design This parallel, single-blind, randomized controlled trial was conducted from March to November 2022 at the Department of Orthopedic and Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. The study protocol was approved by the Siriraj Institutional Review Board (Si-671/2564) and registered with the Thai Clinical Trials Registry (TCTR20220123001/ 2022-01-21). The study adhered to the principles of the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants prior to study initiation. The trial followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines for randomized trials. Participants Eligible participants were elderly patients aged 60 to 90 years with diagnosed fragility hip fractures who underwent surgery within 48 hours of admission. The inclusion criteria required participants to: Communicate in Thai. Possess capable cognitive function, defined as a Thai Mental State Examination score greater than 20. 16 Be able to walk independently or with a gait aid for at least 5 meters before the fracture. Be permitted to ambulate with weight-bearing as tolerated postsurgery. Have a caregiver available to support exercise activities. The exclusion criteria were pathologic fractures, postoperative complications impairing exercise ability, severe cardiovascular or respiratory diseases, dementia, musculoskeletal problems, hemiparesis, psychiatric disorders, and the presence of a cardiac pacemaker. A physiatrist (P.D.) screened and enrolled participants. Eligible participants and their caregivers were informed about the study’s objectives, procedures, and privacy measures. After the baseline assessments, the participants were randomly assigned to either the intervention or the control group. Randomization and Blinding Randomization was achieved via computer-generated blocks of four, with preprepared random numbers concealed in sequentially numbered opaque envelopes. A physiatrist (J.K.), blinded to the baseline results, opened these envelopes to assign interventions. Figure 1 illustrates the participant recruitment and retention flowchart. Thirty-three participants completed the trial and were included in the intention-to-treat analysis. Outcome Measures Research assistants collected baseline demographic data before hospital discharge. The items were age, sex, body mass index (BMI), ambulation status, nutritional status via the Mini Nutritional Assessment–Short Form 17 details of falls, type of femoral fracture, and surgical procedures. were collected by research assistants before hospital discharge. Clinical assessments were conducted at baseline and at 6 and 12 weeks post discharge by a physiotherapist blinded to the group allocations. The primary outcome measure was the short physical performance battery (SPPB), which has good to excellent test-retest reliability (intraclass correlation coefficient 0.72–0.92). 18 The secondary outcome measures were as follows: Two-minute walk test (2MWT). This test assesses walking endurance; the intraclass correlation coefficient is 0.95. 19 Knee extension strength. This strength was measured via a hand-held dynamometer. Anxiety level. This was evaluated via the Thai Hospital Anxiety and Depression Scale 20 Fall incidence. This was tracked through patient and caregiver interviews. No trial outcome changes occurred during the study. Intervention Group The participants in the intervention group received a telerehabilitation program within 1 week after discharge and engaged in a 12-week teleresistance exercise regimen. Each session comprised a warm-up, resistance exercises, and a cool-down. A range of motion and stretching exercises were used for the warm-up and cool-down. The resistance component focused on progressive strengthening of the upper and lower extremities, with weights increasing by 0.5 to 1 kg, as tolerated. The upper extremity exercises targeted the muscles around the shoulders and elbows, whereas the lower extremity exercises focused on the muscles around the hips, knees, and ankles. During the first 6 weeks, the participants completed real-time videoconference exercises with a physiotherapist via the LINE application three times per week, with each session lasting approximately 45 minutes. In weeks 7 to 12, the number of sessions decreased to twice weekly, with an additional self-directed exercise session once weekly. The participants also received an exercise booklet containing textual instructions, pictures, and video clips. Control Group The participants in the control group received usual care, which included an exercise booklet with textual instructions and pictures. The exercises comprised range-of-motion and resistance exercises for the hip, knee, and ankle muscles. The exercises were to be performed as 8 to 10 repetitions per set, with three sets per day at least 3 days per week. Adjunct Therapies Both groups received daily oral nutritional supplements 400 Kcal/day, 1000 mg calcium carbonate, and 40 000 IU ergocalciferol during hospitalization and for 3 months postdischarge. Standard in-hospital physical therapy was provided, along with fall prevention education and occupational therapy for home modifications. The participants were instructed on appropriate self-care on the basis of their type of surgery. Before discharge, the participants and caregivers were trained on a home-based exercise program and were advised to engage in walking exercises (10 minutes per session, three times a day, at least 3 days per week) for 12 weeks. Compliance logs were maintained, and participants were advised to avoid other therapy programs during the study period. Sample Size Calculation The sample size estimation was based on SPPB data from Ninlerd et al. 21 The nQuery Advisor program was used for two-group t tests with equal means. The estimation used a control group mean SPPB score of 6.7, a standard deviation of 1.5, a minimal clinically important difference of 1.34, a power of 80%, and a significance level (α) of 0.05. The required sample size was 21 participants per group. Statistical Analysis Statistical analyses were conducted using SPSS version 29. 22 The Shapiro-Wilk test was employed to assess the normality of data distribution. Continuous variables that exhibited a normal distribution—specifically age, body mass index (BMI), Short Physical Performance Battery (SPPB) scores, two-minute walk test (2MWT) results, knee extension strength, and anxiety scores—are reported as means with standard deviations. Conversely, non-normally distributed outcomes, such as the Mini Nutritional Assessment scores, are presented as medians along with interquartile ranges. Categorical variables are expressed as frequencies and percentages. Differences in baseline characteristics between the control and intervention groups were analyzed using independent samples t-tests for continuous outcomes and chi-square tests for categorical outcomes. Furthermore, the differences in outcomes measured at baseline compared to 6 weeks and baseline compared to 12 weeks between the two groups were evaluated using one-sample t-tests. All data analyses were performed using an intention-to-treat approach, with the last observation carried forward where applicable. A p-value of less than 0.05 was deemed statistically significant. RESULTS Participant Flow and Baseline Characteristics Between March and November 2022, 174 patients with fragility hip fractures were assessed for eligibility. Among these, 141 were excluded for various reasons: 31 due to age limitations, 79 due to medical conditions that precluded participation in tele-resistance exercises, 20 lacked caregivers to support tele-exercise, and 11 declined to participate ( Figure 1 ). Consequently, 33 patients were enrolled in the study, with an average age of 76.8 ± 8.62 years; 27 participants (81.8%) were women. The mean BMI was 23.9 ± 3.95 kg/m 2 . Common comorbidities were hypertension, dyslipidemia, and diabetes mellitus. Most participants were at risk of malnutrition. All individuals were able to walk independently in the community prior to their fracture, had a history of indoor falls between 6 AM and 6 PM, and primarily had femoral neck fractures treated with arthroplasty. After the baseline assessments, the participants were randomly allocated to the control and intervention groups. The demographic and clinical characteristics of each group were not significantly different (Table 1). However, participants in the control group were older, had a higher BMI, and used gait aids more often than those in the intervention group. Table 1 Demographic and clinical characteristics of the participants Control group (n=1 7 ) Intervention group (n=1 6 ) P-value Gender [n (%)] Female Male 15 (88.2) 2 (11.8) 12 (75.0) 4 (25.0) 0.398 Age (years)* 78.3 ± 7.66 75.1 ± 9.51 0.299 BMI (kg/m 2 )* 25.1 ± 4.49 22.7 ± 2.95 0.083 Comorbidities [n (%)] Hypertension Diabetes mellitus Dyslipidemia Osteoarthritis Cardiovascular disease Pulmonary disease Stroke 12 (85.7) 4 (28.6) 9 (64.3) 4 (28.6) 2 (14.3) 1 (7.1) 1 (7.1) 9 (69.2) 6 (46.2) 8 (61.5) 4 (30.8) 0 (0.0) 0 (0.0) 0 (0.0) 0.385 0.440 1.000 1.000 0.481 1.000 1.000 Mini nutritional assessment 9 (8,12) 10.5 (9.25,11.75) 0.326 Premorbid walking function Use gait aid 5 (29.4) 2 (12.5) 0.175 Type of fracture [n (%)] Fracture neck of femur Trochanteric fracture 14 (82.3) 3 (17.7) 11 (68.7) 5 (31.0) 0.305 Surgery [n (%)] Arthroplasty Internal fixation 13 (76.5) 4 (23.5) 10 (62.5) 6 (37.5) 0.702 *mean + SD, **median (IQR), a significant at p value<0.05, IQR: Interquartile range Primary Outcome: Improvements in SPPB Scores The Short Physical Performance Battery (SPPB) scores at baseline, 6 weeks, and 12 weeks for both the control and intervention groups are presented (Figure 2A). Significant improvements from baseline were observed in both groups at 6 weeks (control group: P = 0.046; intervention group: P = 0.026) and at 12 weeks (control group: P = 0.007; intervention group: P < 0.001) (Table 2). Notably, there were no significant differences between the groups at baseline and 6 weeks. However, at 12 weeks, the changes in SPPB scores from baseline indicated a significant difference between the control and intervention groups (P = 0.040), with the intervention group exhibiting significantly greater improvements compared to the control group. Secondary Outcomes 2-Minute Walk Test (2MWT) The distances achieved in the 2MWT at baseline, 6 weeks, and 12 weeks for both groups are illustrated Figure 2B). There were no significant differences between the control and intervention groups at baseline. Both groups demonstrated significant improvements from baseline at 6 weeks (control group: P = 0.002; intervention group: P < 0.001) and at 12 weeks (both groups: P < 0.001). At the 6-week mark, the intervention group exhibited significantly greater changes in 2MWT distance compared to the control group (P = 0.032), although no significant difference was observed at 12 weeks (P = 0.074) (Table 2). Knee Extension Strength Knee extension strength, measured on both sides at baseline, 6 weeks, and 12 weeks, is presented (Figures 2C and 2D). At baseline, there was no significant difference in knee strength of the fractured side between the groups (P = 0.292). The change in knee extension strength within the control group from baseline to 6 weeks was not statistically significant (P = 0.054); however, a significant change was observed from baseline to 12 weeks (P = 0.004). Conversely, the intervention group demonstrated significant changes in knee extension strength from baseline to both 6 weeks (P = 0.008) and 12 weeks (P = 0.005). Between-group comparisons revealed no significant differences in changes in knee extension strength from baseline to 6 weeks (P = 0.282) or from baseline to 12 weeks (P = 0.409) (Table 2). Regarding the sound side, the baseline knee strength in the intervention group was significantly greater than that of the control group (P = 0.041). The control group exhibited significant changes in knee extension strength from baseline to both 6 weeks (P = 0.023) and 12 weeks (P = 0.017). In contrast, the intervention group showed no significant changes from baseline to either 6 weeks (P = 0.100) or 12 weeks (P = 0.199). Additionally, there were no significant differences between groups at both time points (6 weeks: P = 0.757; 12 weeks: P = 0.532) (Table 2). Anxiety Scores Anxiety scores at baseline, 6 weeks, and 12 weeks for both groups are depicted (Figure 2E). At baseline, there were no significant differences in anxiety scores between the control and intervention groups (P = 0.34). The changes in anxiety scores from baseline to 6 weeks (P = 0.017) and from baseline to 12 weeks (P = 0.014) were significant within the control group. In the intervention group, no significant difference was observed in anxiety scores from baseline to 6 weeks (P = 0.131), while a significant difference was noted from baseline to 12 weeks (P = 0.003). Between-group comparisons indicated no significant differences at both 6 weeks (P = 0.424) and 12 weeks (P = 0.680) (Table 2). Table 2 Changes in outcomes from baseline to 6 weeks and baseline to 12 weeks Outcomes Baseline Change in 6weeks (95% CI) Change in 12 weeks (95% CI) P-value 6wk s P-value 12wk s SPPB Control 3.29 + 1.99 1.00 (0.02,1.98) 1.76 (0.57,2.96) 0.046* 0.007* Intervention 3.69 + 1.78 1.63 (0.22,3.03) 3.63 (2.21,5.04) 0.026* <0.001* P-value 0.555 0.438 0.040* 2 MWT (meters) Control 9.36 + 4.44 11.05 (4.60,17.50) 25.57 (13.48,37.67) 0.002* <0.001* Intervention 13.61 + 8.37 25.04 (13.16,36.92) 45.21 (26.26,64.16) <0.001* <0.001* P- value 0.076 0.032* 0.074 KE strength: fractured side (Kg) Control 49.95 + 17.37 7.71 (-0.16,15.58) 12.12 (4.58,19.66) 0.054 0.004* Intervention 56.59 + 18.15 14.19 (4.29,24.09) 17.43 (6.06,28.79) 0.008* 0.005* P-value 0.292 0.282 0.409 KE strength: sound side (Kg) Control 60.18 + 15.38 10.29 (1.60,18.98) 14.05 (2.87,25.23) 0.023* 0.017* Intervention 74.48 + 22.65 8.33 (-1.80,18.47) 8.78 (-5.14,22.70) 0.100 0.199 P-value 0.041* 0.757 0.532 Anxiety score Control 5.53 + 2.79 2.06 (0.42,3.70) 2.12 (0.48,3.75) 0.017* 0.014* Intervention 4.56 + 2.94 1.19 (-0.04,2.77) 2.56 (0.99,4.13) 0.131 0.003* p-value 0.340 0.424 0.680 *significant at p value <0.05, 95%CI: 95% confidence interval, SPPB:Short Physical Performance Battery, 2MWT: 2 minute walk test, KE: knee extension Number of Falls Within the intervention group, one participant (6.7%) experienced a fall within 6 weeks of discharge, which was deemed unrelated to the tele-resistance exercise program. No serious complications were reported. DISCUSSION Impact of Telerehabilitation on Physical Function Immobilization after major surgery and during hospitalization can substantially decrease muscle strength and function. Physical training has been shown to improve strength and functional performance in patients recovering from hip fractures. 23 This study demonstrated that telerehabilitation programs, specifically tele-resistance exercises, can significantly enhance physical function in elderly patients following hip fracture surgery. At 12 weeks postintervention, the improvements were particularly notable compared with those achieved with traditional exercise booklets. This is the first study to implement such a program for fragility hip fractures in Thailand. Advantages of Real-Time Video Conferencing The intervention employed real-time video conferencing through the LINE application to deliver exercises and provide immediate feedback from physiotherapists. This method differs from other telerehabilitation approaches, which typically use prerecorded videos or less interactive platforms. 15 The ability to offer real-time feedback allowed for personalized adjustments, likely contributing to the observed improvements in physical function. Additionally, participants could use smartphones or tablets with a standard application, making this telerehabilitation approach more accessible and cost-effective than systems relying on complex technology. Challenges with Traditional Rehabilitation Rehabilitation after surgery primarily aims to restore mobility. In the standard approach, older adults with hip fractures and their caregivers typically receive training on home exercise programs upon discharge, supplemented by an exercise booklet. However, clinical observations have shown that some patients struggle to follow and progress with these exercises, leading to delayed mobility recovery. Furthermore, mobility issues often prevent patients from receiving outpatient therapy, as they rely on caregiver assistance and face transportation challenges. These barriers can exacerbate inequities in healthcare access, particularly for those in remote or underserved areas. The trial addressed these limitations by introducing a more structured and accessible alternative the 12-week tele-resistance exercise program which allowed patients to receive rehabilitation remotely. This approach not only enhances accessibility but also potentially reduces inequities in healthcare access, aligning with the sustainable development goals. 24 Safety Considerations in Telerehabilitation Safety is paramount in remote exercise programs. Therefore, 110 patients who were considered unsafe for telerehabilitation were excluded from the study. There were 31 participants with extreme ages and 79 conditions that could prohibit active exercise were excluded from the study. A meta-analysis reported that physiotherapist-led, exercise-based telerehabilitation is noninferior to face-to-face rehabilitation and superior to no intervention for older adults with musculoskeletal conditions. 25 Systematic reviews have also indicated that progressive resistance exercises following hip fracture surgery improve mobility, activities of daily living, balance, lower-limb strength, and performance in various tasks. 26 Therefore, tele-resistance exercise was selected as the intervention. Tele-resistance exercise showed an adherence rate of 70%, demonstrating its superior effectiveness compared to using exercise booklets demonstrating its effectiveness compared to exercise booklets. Primary Outcome: Improvements in SPPB Scores The SPPB served as the primary outcome measure for assessing balance, gait, strength, and endurance in the study groups. Previous meta-analyses have shown significant differences in SPPB scores between home-based digital health interventions and control groups, with mean differences indicating improvement. 15 Notably, the intervention group in the present study showed a median increment of 3.5 points in the SPPB score at 12 weeks, which exceeds the substantial meaningful change threshold for older adults. 27 This finding suggests that real-time telerehabilitation can effectively tailor exercise intensity and progression on the basis of individual capabilities, thereby facilitating improved physical outcomes. This outcome underscores that supervised resistance training improves physical performance measures more than unsupervised programs do in older adults. 28 2MWT and Muscle Strength Similar positive trends were observed in the 2MWT, where the intervention group outperformed the control group at 6 weeks. However, the changes of distance at 12 weeks did not reveal the significant difference between the control and intervention groups. Notably, the intervention group could walker for longer distance at both time points. The median improvement of 21.4 meters exceeded the minimum detectable change for older adults, 19 indicating meaningful functional gains in the intervention group. This result aligns with other research showing a strong correlation between 2MWT performance and peak oxygen uptake during rehabilitation after hip fractures. 29 However, some studies have not supported these findings, 30, 31 suggesting that improvements in walking distance may primarily result from gains in muscle strength due to progressive resistance exercises. 30 Interestingly, our study did not find significant differences in knee extension strength between the groups, contrary to other research highlighting the benefits of resistance exercises. This lack of significant findings may be attributed to the relatively low volume and intensity of training (0.5‒1 kg), which may not be sufficient for substantial strength gains. It is also possible that hip fracture elderly had high prevalence of sarcopenia 32 which is difficult to improve with such short period of exercises. High-intensity progressive resistance training and adequate training volume are critical for improving lower-limb strength more effectively than lower intensity training and training volume. 33 Additionally, once participants were able to ambulate, their compliance with resistance exercises may have decreased. Anxiety Levels and Cultural Considerations Anxiety scores improved in both groups, although no significant differences were noted between the telerehabilitation and control groups. This result contrasts with findings from Wu et al, who reported lower anxiety scores in telerehabilitation participants. 34 However, our results align with existing evidence that physical exercise positively impacts anxiety levels in the elderly. 35 Additionally, in Thai culture, families often provide care for older relatives, which may have contributed to the relatively low baseline anxiety scores and improvements over time due to family support and physical recovery. Safety and Adverse Events Importantly, our study did not report any adverse effects or deaths related to the tele-resistance exercise program. One fall occurred in the intervention group; however, it was unrelated to the exercise program and did not result in serious complications. This study underscores the effectiveness of home-based digital health interventions involving communication, feedback, education, and telerehabilitation, which enhance functional outcomes among older patients recovering from hip fractures postsurgery. 15 Limitations Several limitations must be acknowledged in this study. First, a significant number of patients were excluded due to safety concerns about remote exercise. Since this study was conducted in a tertiary, university-based medical school, the participants may have had more severe health conditions and a higher prevalence of comorbidities compared to those in community-based hospitals. Consequently, the findings may not be applicable to patients in such settings. Second, the relatively small sample size limits the generalizability of the results. This small sample size was partly due to recruitment challenges toward the end of 2022. During this period, many caregivers who were proficient in using smart devices and the LINE video call application had to resume on-site work, reducing their availability to support patients in the telerehabilitation program. Then some of the participants were institutionalized during this time, further limiting the pool of eligible participants. Increasing the sample size in future research could enhance the robustness of the findings. Additionally, the current study employed a conventional approach that included an exercise booklet and a home exercise program provided prior to discharge. This approach resulted in reduced therapist interaction for the control group, which may have negatively influenced their physical outcomes. Moreover, the participants in the control group were older and utilized gait aids more frequently compared to those in the intervention group. Previous research has established that older age and reduced walking abilities were associated with diminished functional recovery following hip fractures. 6, 36 Therefore, it is possible that the control group experienced poorer recovery outcomes than the intervention group. For future studies, the Short Physical Performance Battery (SPPB), which consists of three distinct tests—standing balance, gait speed, and chair stand tests—should be analyzed to assess the impact of telerehabilitation exercises on each component individually. This approach would facilitate the development of more targeted exercise programs. Finally, investigating the long-term effects of telerehabilitation is crucial for evaluating the sustainability of the observed benefits CONCLUSIONS Tele-resistance exercise programs are feasible and effective alternatives to traditional exercise booklets for improving physical function in elderly patients after hip fracture surgery. Notable benefits are evident after 12 weeks. The programs address the challenges of accessing rehabilitation services and enhance patient outcomes in this demographic. Future research should focus on evaluating the long-term effects and optimizing exercise protocols for telerehabilitation. Abbreviations SPPB: short physical performance battery, 2MWT: 2-minute walk test, KE: knee extension, BMI: body mass index Declarations Ethics approval and consent to participate The study protocol was approved by the Siriraj Institutional Review Board (Si-671/2564). Written informed consent was obtained from all participants prior to study initiation. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research project is supported by Siriraj Research Development Fund (Managed by Routine to Research: R2R) Grant Number IO-R01635015 Faculty of Medicine Siriraj Hospital, Mahidol University Author contributions PD and JK conceived the study, designed the protocol, analyzed the data, and prepared the manuscript. RY, PC, KK, and TC designed the protocol and assisted with the data collection. AU, EV, VS, and US participated in the study design, and commented on the manuscript. All authors read and approved the final version of the manuscript. Acknowledgement The authors would like to thank Mr. Sutthipol Udompunturak for his assistance with the statistical analyses. References Orive M, Aguirre U, García-Gutiérrez S, Hayas CL, Bilbao A, González N, et al. Changes in health-related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study. Int J Clin Pract. 2015;69(4):491–500. DOI:10.1111/ijcp.12527. 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Performance-based physical function in older community-dwelling persons: a systematic review of instruments. Age Ageing. 2012;41(6):712-721. DOI:10.1093/ageing/afs099. Connelly D, Thomas B, Cliffe S, Perry W, Smith R. Clinical utility of the 2-minute walk test for older adults living in long-term care. Physiother Can. 2009;61(2):78–87. DOI: 10.3138/physio.61.2.78. Nilchaikovit T, Lortrakul M, Phisansuthideth U. Development of Thai version of Hospital Anxiety and Depression Scale in cancer patients. J Psychiatr Assoc Thailand. 1996;41:18-30. Ninlerd C, Dungkong S, Phuangphay G, Amornsupak C, Narkbunnam R. Effect of home-based rehabilitation exercise program for elderly patients with femoral neck fracture after bipolar hemiarthroplasty. Siriraj Med J. 2020;72(4):307-314. DOI:10.33192/Smj.2020.42. IBM Corp. Released 2023. IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp Suetta C, Magnusson S, Beyer N, Kjaer M. Effect of strength training on muscle function in elderly hospitalized patients. Scand J Med Sci Sports. 2007;17(5):464–472. DOI: 10.1111/j.1600-0838.2007.00712.x. United Nations. Sustainable development goals: goal3 Ensure healthy lives and promote well-being for all at all ages [Internet] [Cited Sep15, 2024]. Available from https://wwwunorg/sustainabledevelopment/health/. Wicks M, Dennett AM, Peiris CL. Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis. Age and Ageing. 2023;52(11):1-13. DOI:10.1093/ageing/afad207. Lee SY, Yoon BH, Beom J, Ha YC, Lim JY. Effect of Lower-Limb Progressive Resistance Exercise After Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Am Med Dir Assoc. 2017;18(12):1096.e19-1096.e26. DOI:10.1016/j.jamda.2017.08.021. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743-9. DOI:10.1111/j.1532-5415.2006.00701.x. Lacroix A, Hortobágyi T, Beurskens R, Granacher U. Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: a systematic review and meta-analysis. Sports Med. 2017;47(11):2341-2361. DOI:10.1007/s40279-017-0747-6. Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture. Arch Phys Med Rehabil. 2008;89(4):609-617. DOI: 10.1016/j.apmr.2007.09.036. Gil-Calvo M, de Paz JA, Herrero-Molleda A, Zecchin A, Gómez-Alonso MT, Alonso-Cortés B, et al. The 2-minutes walking test is not correlated with aerobic fitness indices but with the 5-times sit-to-stand test performance in apparently healthy older adults. Geriatrics (Basel). 2024;9(2):43. DOI: 10.3390/geriatrics9020043. Beckerman H, Heine M, van den Akker LE, de Groot V. The 2-minute walk test is not a valid method to determine aerobic capacity in persons with multiple sclerosis. NeuroRehabilitation. 2019;45(2):239-245. DOI: 10.3233/NRE-192792. Dionyssiotis Y, de León AO. Sarcopenia and Hip Fractures. J Frailty Sarcopenia Falls. 2024;9(1):1-3. DOI: 10.22540/JFSF-09-001. Raymond MJ, Bramley-Tzerefos RE, Jeffs KJ, Winter A, Holland AE. Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Arch Phys Med Rehabil. 2013;94(8):1458-1472. DOI:10.1016/j.apmr.2013.02.022. Wu WY, Zhang YG, Zhang YY, Peng B, Xu WG. Clinical effectiveness of home-based telerehabilitation program for geriatric hip fracture following total hip replacement. Orthop Surg. 2022;15(2):423-431. DOI: 10.1111/os.13521. Wu F, Zhang J, Yang H, Jiang J. The effect of physical exercise on the elderly's anxiety: based on systematic reviews and meta-analysis. Comput Math Methods Med. 2022;2022:4848290. DOI: 10.1155/2022/4848290 Takahashi A, Naruse H, Kitade I, Shimada S, Tsubokawa M, Kokubo Y, et al. Functional outcomes after the treatment of hip fracture. PLoS One. 2020;15(7):e0236652. DOI: 10.1371/journal.pone.0236652. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 Aug, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 20 May, 2025 Reviews received at journal 03 May, 2025 Reviewers agreed at journal 03 May, 2025 Reviewers agreed at journal 04 Mar, 2025 Reviewers agreed at journal 27 Feb, 2025 Reviews received at journal 26 Jan, 2025 Reviewers agreed at journal 09 Jan, 2025 Reviewers agreed at journal 05 Jan, 2025 Reviewers agreed at journal 05 Jan, 2025 Reviewers invited by journal 03 Jan, 2025 Editor invited by journal 11 Nov, 2024 Editor assigned by journal 08 Nov, 2024 Submission checks completed at journal 08 Nov, 2024 First submitted to journal 03 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5382513\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":380045448,\"identity\":\"c626366d-2f5e-4ed5-997c-131994dc4761\",\"order_by\":0,\"name\":\"Piyapat 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14:38:07\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5382513/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5382513/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12877-025-06230-y\",\"type\":\"published\",\"date\":\"2025-08-20T16:30:32+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":71144221,\"identity\":\"83bf06ba-6b9e-4150-b62f-d799d4f236f1\",\"added_by\":\"auto\",\"created_at\":\"2024-12-11 14:10:08\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":99342,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003estudy flow diagram\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.0.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5382513/v1/90e51de450c2e921e2d70141.jpg\"},{\"id\":71144222,\"identity\":\"6892072c-74aa-4495-9d82-72e3220cff7e\",\"added_by\":\"auto\",\"created_at\":\"2024-12-11 14:10:08\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":622408,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eOutcome measures at different time points\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5382513/v1/f0d15a0a07f28add378bf0aa.png\"},{\"id\":89847542,\"identity\":\"503e8657-7f8e-4510-ab50-206fbe47c85e\",\"added_by\":\"auto\",\"created_at\":\"2025-08-25 16:43:40\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1849953,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5382513/v1/8fe15176-3c97-44a9-ba34-59fcbfc01b9a.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Feasibility and Efficacy of Real-time Teleresistance Exercise Programs for Physical Function in Elderly Patients After Hip Fracture Surgery: A Randomized Controlled Trial\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eHip fractures are major public health issues that significantly affect patients\\u0026rsquo; quality of life, functional ability,\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e and overall health. They also impose substantial costs on healthcare systems.\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/sup\\u003e The incidence of hip fractures varies widely worldwide. Between 2005 and 2018, rates ranged from 95.1 per 100 000 in Brazil to 315.9 per 100 000 in Denmark. As the population ages, the number of hip fractures is expected to double by 2050, impacting both men and women. The incidence sharply increases with age.\\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e In Thailand, osteoporotic hip fractures are a growing concern. Crude incidence rates rose from 112.7 per 100 000 in 2013 to 146.9 per 100 000 in 2022. During the same period, annual hospitalization costs surged from 17.3\\u0026nbsp;million USD to 42.8\\u0026nbsp;million USD.\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe median one-year mortality rate after hip fracture is 22.8%.\\u003csup\\u003e3\\u003c/sup\\u003e Survivors often experience marked declines in mobility, independence, and health-related quality of life.\\u003csup\\u003e\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e Between 33% and 69% struggle to return to prefracture daily activities, and 20\\u0026ndash;66% cannot regain their previous mobility within 6 months.\\u003csup\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e Rehabilitation is essential for restoring independence,\\u003csup\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e with evidence supporting the effectiveness of multidisciplinary inpatient rehabilitation.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e Both outpatient and home-based rehabilitation have proven beneficial.\\u003csup\\u003e\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e Systematic reviews indicate that home-based approaches can match inpatient options for appropriate patients.\\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/sup\\u003e Notably, progressive resistance exercises can significantly improve mobility, daily activities, balance, and strength.\\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn Thailand, barriers to accessing rehabilitation include limited healthcare resources, socioeconomic challenges, travel difficulties, and the impact of the COVID-19 pandemic. These factors have hindered continuous rehabilitation efforts. Telerehabilitation has emerged as a promising solution to these challenges. Previous studies have indicated that telerehabilitation is feasible, safe, and effective for home-based rehabilitation in older adults following hip fractures.\\u003csup\\u003e\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u003c/sup\\u003e However, most existing research has focused on asynchronous telerehabilitation methods,\\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u003c/sup\\u003e which lack real-time coaching and feedback. Given the aging population and rising incidence of hip fractures in Thailand, this study aimed to evaluate the feasibility and effectiveness of real-time telerehabilitation resistance exercise programs compared with traditional rehabilitation methods in terms of physical function.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003ch2\\u003e\\u003cstrong\\u003eStudy Design\\u003c/strong\\u003e\\u003c/h2\\u003e\\n\\u003cp\\u003eThis parallel, single-blind, randomized controlled trial was conducted from March to November 2022 at the Department of Orthopedic and Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. The study protocol was approved by the Siriraj Institutional Review Board (Si-671/2564) and registered with the Thai Clinical Trials Registry (TCTR20220123001/ 2022-01-21). The study adhered to the principles of the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants prior to study initiation. The trial followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines for randomized trials.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eParticipants\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEligible participants were elderly patients aged 60 to 90 years with diagnosed fragility hip fractures who underwent surgery within 48 hours of admission. The inclusion criteria required participants to:\\u003c/p\\u003e\\n\\u003cul class=\\\"decimal_type\\\"\\u003e\\n \\u003cli\\u003eCommunicate in Thai.\\u003c/li\\u003e\\n \\u003cli\\u003ePossess capable cognitive function, defined as a Thai Mental State Examination score greater than 20.\\u003csup\\u003e16\\u003c/sup\\u003e\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBe able to walk independently or with a gait aid for at least 5 meters before the fracture.\\u003c/li\\u003e\\n \\u003cli\\u003eBe permitted to ambulate with weight-bearing as tolerated postsurgery.\\u003c/li\\u003e\\n \\u003cli\\u003eHave a caregiver available to support exercise activities.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eThe exclusion criteria were pathologic fractures, postoperative complications impairing exercise ability, severe cardiovascular or respiratory diseases, dementia, musculoskeletal problems, hemiparesis, psychiatric disorders, and the presence of a cardiac pacemaker.\\u003c/p\\u003e\\n\\u003cp\\u003eA physiatrist (P.D.) screened and enrolled participants. Eligible participants and their caregivers were informed about the study\\u0026rsquo;s objectives, procedures, and privacy measures.\\u0026nbsp;After the baseline assessments, the participants were randomly assigned to either the intervention or the control group.\\u003c/p\\u003e\\n\\u003ch2\\u003eRandomization and Blinding\\u003c/h2\\u003e\\n\\u003cp\\u003eRandomization was achieved via computer-generated blocks of four, with preprepared random numbers concealed in sequentially numbered opaque envelopes. A physiatrist (J.K.), blinded to the baseline results, opened these envelopes to assign interventions. \\u003cstrong\\u003eFigure 1\\u003c/strong\\u003e illustrates the participant recruitment and retention flowchart. Thirty-three participants completed the trial and were included in the intention-to-treat analysis.\\u003c/p\\u003e\\n\\u003ch2\\u003eOutcome Measures\\u003c/h2\\u003e\\n\\u003cp\\u003eResearch assistants collected baseline demographic data before hospital discharge. The items were age, sex, body mass index (BMI), ambulation status, nutritional status via the Mini Nutritional Assessment\\u0026ndash;Short Form \\u003csup\\u003e17\\u003c/sup\\u003e details of falls, type of femoral fracture, and surgical procedures. were collected by research assistants before hospital discharge.\\u003c/p\\u003e\\n\\u003cp\\u003eClinical assessments were conducted at baseline and at 6 and 12 weeks post discharge by a physiotherapist blinded to the group allocations. The primary outcome measure was the short physical performance battery (SPPB), which has good to excellent test-retest reliability (intraclass correlation coefficient 0.72\\u0026ndash;0.92). \\u003csup\\u003e18\\u003c/sup\\u003e\\u0026nbsp; \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe secondary outcome measures were as follows:\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eTwo-minute walk test (2MWT). This test assesses walking endurance; the intraclass correlation coefficient is 0.95. \\u003csup\\u003e19\\u003c/sup\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003eKnee extension strength. This strength was measured via a hand-held dynamometer.\\u003c/li\\u003e\\n \\u003cli\\u003eAnxiety level. This was evaluated via the Thai Hospital Anxiety and Depression Scale \\u003csup\\u003e20\\u003c/sup\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003eFall incidence.\\u0026nbsp;This was tracked through patient and caregiver interviews.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eNo trial outcome changes occurred during the study.\\u003c/p\\u003e\\n\\u003ch2\\u003eIntervention Group\\u003c/h2\\u003e\\n\\u003cp\\u003eThe participants in the intervention group received a telerehabilitation program within 1 week after discharge and engaged in a 12-week teleresistance exercise regimen. Each session comprised a warm-up, resistance exercises, and a cool-down. A range of motion and stretching exercises were used for the warm-up and cool-down. The resistance component focused on progressive strengthening of the upper and lower extremities, with weights increasing by 0.5 to 1 kg, as tolerated. The upper extremity exercises targeted the muscles around the shoulders and elbows, whereas the lower extremity exercises focused on the muscles around the hips, knees, and ankles.\\u003c/p\\u003e\\n\\u003cp\\u003eDuring the first 6 weeks, the participants completed real-time videoconference exercises with a physiotherapist via the LINE application three times per week, with each session lasting approximately 45 minutes. In weeks 7 to 12, the number of sessions decreased to twice weekly, with an additional self-directed exercise session once weekly. The participants also received an exercise booklet containing textual instructions, pictures, and video clips.\\u003c/p\\u003e\\n\\u003ch2\\u003eControl Group\\u003c/h2\\u003e\\n\\u003cp\\u003eThe participants in the control group received usual care, which included an exercise booklet with textual instructions and pictures. The exercises comprised range-of-motion and resistance exercises for the hip, knee, and ankle muscles. The exercises were to be performed as 8 to 10 repetitions per set, with three sets per day at least 3 days per week.\\u003c/p\\u003e\\n\\u003ch2\\u003eAdjunct Therapies\\u003c/h2\\u003e\\n\\u003cp\\u003eBoth groups received daily oral nutritional supplements 400 Kcal/day, 1000 mg calcium carbonate, and 40\\u0026nbsp;000 IU ergocalciferol during hospitalization and for 3 months postdischarge. Standard in-hospital physical therapy was provided, along with fall prevention education and occupational therapy for home modifications. The participants were instructed on appropriate self-care on the basis of their type of surgery. Before discharge, the participants and caregivers were trained on a home-based exercise program and were advised to engage in walking exercises (10 minutes per session, three times a day, at least 3 days per week) for 12 weeks. Compliance logs were maintained, and participants were advised to avoid other therapy programs during the study period.\\u003c/p\\u003e\\n\\u003ch2\\u003eSample Size Calculation\\u003c/h2\\u003e\\n\\u003cp\\u003eThe sample size estimation was based on SPPB data from Ninlerd et al.\\u003csup\\u003e21\\u003c/sup\\u003e The nQuery Advisor program was used for two-group t tests with equal means. The estimation used a control group mean SPPB score of 6.7, a standard deviation of 1.5, a minimal clinically important difference of 1.34, a power of 80%, and a significance level (\\u0026alpha;) of 0.05. The required sample size was 21 participants per group.\\u003c/p\\u003e\\n\\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e\\n\\u003cp\\u003eStatistical analyses were conducted using SPSS version 29.\\u003csup\\u003e22\\u003c/sup\\u003e The Shapiro-Wilk test was employed to assess the normality of data distribution. Continuous variables that exhibited a normal distribution\\u0026mdash;specifically age, body mass index (BMI), Short Physical Performance Battery (SPPB) scores, two-minute walk test (2MWT) results, knee extension strength, and anxiety scores\\u0026mdash;are reported as means with standard deviations. Conversely, non-normally distributed outcomes, such as the Mini Nutritional Assessment scores, are presented as medians along with interquartile ranges. Categorical variables are expressed as frequencies and percentages.\\u003c/p\\u003e\\n\\u003cp\\u003eDifferences in baseline characteristics between the control and intervention groups were analyzed using independent samples t-tests for continuous outcomes and chi-square tests for categorical outcomes. Furthermore, the differences in outcomes measured at baseline compared to 6 weeks and baseline compared to 12 weeks between the two groups were evaluated using one-sample t-tests. All data analyses were performed using an intention-to-treat approach, with the last observation carried forward where applicable. A p-value of less than 0.05 was deemed statistically significant.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003ch2\\u003eParticipant Flow and Baseline Characteristics\\u003c/h2\\u003e\\n\\u003cp\\u003eBetween March and November 2022, 174 patients with fragility hip fractures were assessed for eligibility. Among these, 141 were excluded for various reasons: 31 due to age limitations, 79 due to medical conditions that precluded participation in tele-resistance exercises, 20 lacked caregivers to support tele-exercise, and 11 declined to participate (\\u003cstrong\\u003eFigure 1\\u003c/strong\\u003e). Consequently, 33 patients were enrolled in the study, with an average age of 76.8 \\u003cstrong\\u003e\\u0026plusmn;\\u003c/strong\\u003e 8.62 years; 27 participants (81.8%) were women.\\u003c/p\\u003e\\n\\u003cp\\u003eThe mean BMI was 23.9 \\u003cstrong\\u003e\\u0026plusmn;\\u003c/strong\\u003e 3.95 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e. Common comorbidities were hypertension, dyslipidemia, and diabetes mellitus. Most participants were at risk of malnutrition. All individuals were able to walk independently in the community prior to their fracture, had a history of indoor falls between 6 AM and 6 PM, and primarily had femoral neck fractures treated with arthroplasty.\\u003c/p\\u003e\\n\\u003cp\\u003eAfter the baseline assessments, the participants were randomly allocated to the control and intervention groups. The demographic and clinical characteristics of each group were not significantly different (Table 1). However, participants in the control group were older, had a higher BMI, and used gait aids more often than those in the intervention group.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1 Demographic and clinical characteristics of the participants\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 34.0037%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eControl group\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003e(n=1\\u003c/strong\\u003e\\u003cstrong\\u003e7\\u003c/strong\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIntervention group (n=1\\u003c/strong\\u003e\\u003cstrong\\u003e6\\u003c/strong\\u003e\\u003cstrong\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eGender [n (%)]\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; Female\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; Male \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e15 (88.2)\\u003c/p\\u003e\\n \\u003cp\\u003e2 (11.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e12 (75.0)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (25.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.398\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eAge (years)*\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e78.3 \\u0026plusmn; 7.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e75.1 \\u0026plusmn; 9.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.299\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e25.1 \\u0026plusmn; 4.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e22.7\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;2.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.083\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eComorbidities [n (%)]\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Hypertension\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Diabetes mellitus\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Dyslipidemia\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Osteoarthritis\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Cardiovascular disease\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Pulmonary disease\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Stroke\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e12 (85.7)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (28.6)\\u003c/p\\u003e\\n \\u003cp\\u003e9 (64.3)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (28.6)\\u003c/p\\u003e\\n \\u003cp\\u003e2 (14.3)\\u003c/p\\u003e\\n \\u003cp\\u003e1 (7.1)\\u003c/p\\u003e\\n \\u003cp\\u003e1 (7.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e9 (69.2)\\u003c/p\\u003e\\n \\u003cp\\u003e6 (46.2)\\u003c/p\\u003e\\n \\u003cp\\u003e8 (61.5)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (30.8)\\u003c/p\\u003e\\n \\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\n \\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\n \\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e0.385\\u003c/p\\u003e\\n \\u003cp\\u003e0.440\\u003c/p\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003cp\\u003e0.481\\u003c/p\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eMini nutritional assessment\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e9 (8,12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e10.5 (9.25,11.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.326\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003ePremorbid walking function\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Use gait aid\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e5 (29.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e2 (12.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.175\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eType of fracture [n (%)]\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Fracture neck of femur\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Trochanteric fracture\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e14 (82.3)\\u003c/p\\u003e\\n \\u003cp\\u003e3 (17.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e11 (68.7)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (31.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.305\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 34.0037%;\\\"\\u003e\\n \\u003cp\\u003eSurgery\\u0026nbsp;[n (%)]\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Arthroplasty\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Internal fixation\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 27.4223%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e13 (76.5)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (23.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 25.4113%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e10\\u0026nbsp;(62.5)\\u003c/p\\u003e\\n \\u003cp\\u003e6 (37.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.1627%;\\\"\\u003e\\n \\u003cp\\u003e0.702\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e*mean \\u003cu\\u003e+\\u003c/u\\u003e SD, **median (IQR), \\u003csup\\u003ea\\u003c/sup\\u003e significant at p value\\u0026lt;0.05, \\u0026nbsp;IQR: Interquartile range\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch2\\u003e\\u003cstrong\\u003ePrimary Outcome: Improvements in SPPB Scores\\u003c/strong\\u003e\\u003c/h2\\u003e\\n\\u003cp\\u003eThe Short Physical Performance Battery (SPPB) scores at baseline, 6 weeks, and 12 weeks for both the control and intervention groups are presented (Figure 2A). Significant improvements from baseline were observed in both groups at 6 weeks (control group: P = 0.046; intervention group: P = 0.026) and at 12 weeks (control group: P = 0.007; intervention group: P \\u0026lt; 0.001) (Table 2). Notably, there were no significant differences between the groups at baseline and 6 weeks. However, at 12 weeks, the changes in SPPB scores from baseline indicated a significant difference between the control and intervention groups (P = 0.040), with the intervention group exhibiting significantly greater improvements compared to the control group.\\u003c/p\\u003e\\n\\u003ch2\\u003e\\u003cstrong\\u003eSecondary Outcomes\\u003c/strong\\u003e\\u003c/h2\\u003e\\n\\u003ch4\\u003e\\u003cstrong\\u003e2-Minute Walk Test (2MWT)\\u003c/strong\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eThe distances achieved in the 2MWT at baseline, 6 weeks, and 12 weeks for both groups are illustrated Figure 2B). There were no significant differences between the control and intervention groups at baseline. Both groups demonstrated significant improvements from baseline at 6 weeks (control group: P = 0.002; intervention group: P \\u0026lt; 0.001) and at 12 weeks (both groups: P \\u0026lt; 0.001). At the 6-week mark, the intervention group exhibited significantly greater changes in 2MWT distance compared to the control group (P = 0.032), although no significant difference was observed at 12 weeks (P = 0.074) (Table 2).\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u003cem\\u003eKnee Extension Strength\\u003c/em\\u003e\\u003c/h3\\u003e\\n\\u003cp\\u003eKnee extension strength, measured on both sides at baseline, 6 weeks, and 12 weeks, is presented (Figures 2C and 2D). At baseline, there was no significant difference in knee strength of the fractured side between the groups (P = 0.292). The change in knee extension strength within the control group from baseline to 6 weeks was not statistically significant (P = 0.054); however, a significant change was observed from baseline to 12 weeks (P = 0.004). Conversely, the intervention group demonstrated significant changes in knee extension strength from baseline to both 6 weeks (P = 0.008) and 12 weeks (P = 0.005). Between-group comparisons revealed no significant differences in changes in knee extension strength from baseline to 6 weeks (P = 0.282) or from baseline to 12 weeks (P = 0.409) (Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding the sound side, the baseline knee strength in the intervention group was significantly greater than that of the control group (P = 0.041). The control group exhibited significant changes in knee extension strength from baseline to both 6 weeks (P = 0.023) and 12 weeks (P = 0.017). In contrast, the intervention group showed no significant changes from baseline to either 6 weeks (P = 0.100) or 12 weeks (P = 0.199). Additionally, there were no significant differences between groups at both time points (6 weeks: P = 0.757; 12 weeks: P = 0.532) (Table 2).\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u003cem\\u003eAnxiety Scores\\u003c/em\\u003e\\u003c/h3\\u003e\\n\\u003cp\\u003eAnxiety scores at baseline, 6 weeks, and 12 weeks for both groups are depicted (Figure 2E). At baseline, there were no significant differences in anxiety scores between the control and intervention groups (P = 0.34). The changes in anxiety scores from baseline to 6 weeks (P = 0.017) and from baseline to 12 weeks (P = 0.014) were significant within the control group. In the intervention group, no significant difference was observed in anxiety scores from baseline to 6 weeks (P = 0.131), while a significant difference was noted from baseline to 12 weeks (P = 0.003). Between-group comparisons indicated no significant differences at both 6 weeks (P = 0.424) and 12 weeks (P = 0.680) (Table 2).\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u0026nbsp;Table 2 Changes in outcomes from baseline to 6 weeks and baseline to 12 weeks\\u0026nbsp;\\u003c/h3\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOutcomes\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBaseline\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChange in 6weeks\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChange in 12 weeks\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003csup\\u003e6wk\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003csup\\u003es\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003csup\\u003e12wk\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003csup\\u003es\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eSPPB\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eControl\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3.29\\u003cu\\u003e+\\u003c/u\\u003e1.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1.00 (0.02,1.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1.76 (0.57,2.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.046*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.007*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIntervention\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3.69\\u003cu\\u003e+\\u003c/u\\u003e1.78\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1.63 (0.22,3.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3.63 (2.21,5.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.026*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.555\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.438\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.040*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e2 MWT (meters)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eControl\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9.36\\u003cu\\u003e+\\u003c/u\\u003e4.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e11.05 (4.60,17.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e25.57 (13.48,37.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.002*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIntervention\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13.61\\u003cu\\u003e+\\u003c/u\\u003e8.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e25.04 (13.16,36.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e45.21 (26.26,64.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP- value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.076\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.032*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.074\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eKE strength: fractured side (Kg)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eControl\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e49.95\\u003cu\\u003e+\\u003c/u\\u003e17.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.71 (-0.16,15.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12.12 (4.58,19.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.054\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.004*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIntervention\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e56.59\\u003cu\\u003e+\\u003c/u\\u003e18.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14.19 (4.29,24.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17.43 (6.06,28.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.008*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.005*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.292\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.282\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.409\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eKE strength: sound side (Kg)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eControl\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e60.18\\u003cu\\u003e+\\u003c/u\\u003e15.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10.29 (1.60,18.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14.05 (2.87,25.23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.023*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.017*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIntervention\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e74.48\\u003cu\\u003e+\\u003c/u\\u003e22.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.33 (-1.80,18.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.78 (-5.14,22.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.199\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.041*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.757\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.532\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAnxiety score\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eControl\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5.53\\u003cu\\u003e+\\u003c/u\\u003e2.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2.06 (0.42,3.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2.12 (0.48,3.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.017*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.014*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIntervention\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4.56\\u003cu\\u003e+\\u003c/u\\u003e2.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1.19 (-0.04,2.77)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2.56 (0.99,4.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.131\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.003*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ep-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.340\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.424\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.680\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e*significant at p value \\u0026lt;0.05, 95%CI: 95% confidence interval,\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSPPB:Short Physical Performance Battery, 2MWT: 2 minute walk test, KE: knee extension\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u003cem\\u003eNumber of Falls\\u003c/em\\u003e\\u003c/h3\\u003e\\n\\u003cp\\u003eWithin the intervention group, one participant (6.7%) experienced a fall within 6 weeks of discharge, which was deemed unrelated to the tele-resistance exercise program. No serious complications were reported.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003ch2\\u003eImpact of Telerehabilitation on Physical Function\\u003c/h2\\u003e\\n\\u003cp\\u003eImmobilization after major surgery and during hospitalization can substantially decrease muscle strength and function. Physical training has been shown to improve strength and functional performance in patients recovering from hip fractures.\\u003csup\\u003e23\\u003c/sup\\u003e This study demonstrated that telerehabilitation programs, specifically tele-resistance exercises, can significantly enhance physical function in elderly patients following hip fracture surgery. At 12 weeks postintervention, the improvements were particularly notable compared with those achieved with traditional exercise booklets. This is the first study to implement such a program for fragility hip fractures in Thailand.\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch2\\u003eAdvantages of Real-Time Video Conferencing\\u003c/h2\\u003e\\n\\u003cp\\u003eThe intervention employed real-time video conferencing through the LINE application to deliver exercises and provide immediate feedback from physiotherapists. This method differs from other telerehabilitation approaches, which typically use prerecorded videos or less interactive platforms.\\u003csup\\u003e15\\u003c/sup\\u003e The ability to offer real-time feedback allowed for personalized adjustments, likely contributing to the observed improvements in physical function. Additionally, participants could use smartphones or tablets with a standard application, making this telerehabilitation approach more accessible and cost-effective than systems relying on complex technology.\\u003c/p\\u003e\\n\\u003ch2\\u003eChallenges with Traditional Rehabilitation\\u003c/h2\\u003e\\n\\u003cp\\u003eRehabilitation after surgery primarily aims to restore mobility. In the standard approach, older adults with hip fractures and their caregivers typically receive training on home exercise programs upon discharge, supplemented by an exercise booklet. However, clinical observations have shown that some patients struggle to follow and progress with these exercises, leading to delayed mobility recovery. Furthermore, mobility issues often prevent patients from receiving outpatient therapy, as they rely on caregiver assistance and face transportation challenges. These barriers can exacerbate inequities in healthcare access, particularly for those in remote or underserved areas. The trial addressed these limitations by introducing a more structured and accessible alternative the 12-week tele-resistance exercise program which allowed patients to receive rehabilitation remotely. This approach not only enhances accessibility but also potentially reduces inequities in healthcare access, aligning with the sustainable development goals.\\u003csup\\u003e24\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch2\\u003eSafety Considerations in Telerehabilitation\\u003c/h2\\u003e\\n\\u003cp\\u003eSafety is paramount in remote exercise programs. Therefore, 110 patients who were considered unsafe for telerehabilitation were excluded from the study. \\u0026nbsp;There were 31 participants with extreme ages and 79 conditions that could prohibit active exercise were excluded from the study. A meta-analysis reported that physiotherapist-led, exercise-based telerehabilitation is noninferior to face-to-face rehabilitation and superior to no intervention for older adults with musculoskeletal conditions.\\u003csup\\u003e25\\u003c/sup\\u003e\\u0026nbsp; \\u0026nbsp;Systematic reviews have also indicated that progressive resistance exercises following hip fracture surgery improve mobility, activities of daily living, balance, lower-limb strength, and performance in various tasks.\\u003csup\\u003e26\\u003c/sup\\u003e\\u0026nbsp; \\u0026nbsp;Therefore, tele-resistance exercise was selected as the intervention. Tele-resistance exercise showed an adherence rate of 70%, demonstrating its superior effectiveness compared to using exercise booklets\\u0026nbsp;demonstrating its effectiveness compared to exercise booklets. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch2\\u003ePrimary Outcome: Improvements in SPPB Scores\\u003c/h2\\u003e\\n\\u003cp\\u003eThe SPPB served as the primary outcome measure for assessing balance, gait, strength, and endurance in the study groups. Previous meta-analyses have shown significant differences in SPPB scores between home-based digital health interventions and control groups, with mean differences indicating improvement.\\u003csup\\u003e15\\u003c/sup\\u003e Notably, the intervention group in the present study showed a median increment of 3.5 points in the SPPB score at 12 weeks, which exceeds the substantial meaningful change threshold for older adults.\\u003csup\\u003e27\\u003c/sup\\u003e This finding suggests that real-time telerehabilitation can effectively tailor exercise intensity and progression on the basis of individual capabilities, thereby facilitating improved physical outcomes. This outcome underscores that supervised resistance training improves physical performance measures more than unsupervised programs do in older adults.\\u003csup\\u003e28\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003ch2\\u003e2MWT and Muscle Strength\\u003c/h2\\u003e\\n\\u003cp\\u003eSimilar positive trends were observed in the 2MWT, where the intervention group outperformed the control group at 6 weeks. However, the changes of distance at 12 weeks did not reveal the significant difference between the control and intervention groups. Notably, the intervention group could walker for longer distance at both time points. \\u0026nbsp;The median improvement of 21.4 meters exceeded the minimum detectable change for older adults,\\u003csup\\u003e19\\u003c/sup\\u003e indicating meaningful functional gains in the intervention group. This result aligns with other research showing a strong correlation between 2MWT performance and peak oxygen uptake during rehabilitation after hip fractures.\\u003csup\\u003e29\\u003c/sup\\u003e However, some studies have not supported these findings,\\u003csup\\u003e30, 31\\u003c/sup\\u003e suggesting that improvements in walking distance may primarily result from gains in muscle strength due to progressive resistance exercises.\\u003csup\\u003e30\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInterestingly, our study did not find significant differences in knee extension strength between the groups, contrary to other research highlighting the benefits of resistance exercises. This lack of significant findings may be attributed to the relatively low volume and intensity of training (0.5‒1 kg), which may not be sufficient for substantial strength gains.\\u0026nbsp;It is also possible that hip fracture elderly had high prevalence of sarcopenia\\u003csup\\u003e32\\u003c/sup\\u003e which is difficult to improve with such short period of exercises. High-intensity progressive resistance training and adequate training volume are critical for improving lower-limb strength more effectively than lower intensity training and training volume.\\u003csup\\u003e33\\u003c/sup\\u003e Additionally, once participants were able to ambulate, their compliance with resistance exercises may have decreased.\\u003c/p\\u003e\\n\\u003ch2\\u003eAnxiety Levels and Cultural Considerations\\u003c/h2\\u003e\\n\\u003cp\\u003eAnxiety scores improved in both groups, although no significant differences were noted between the telerehabilitation and control groups. This result contrasts with findings from Wu et al, who reported lower anxiety scores in telerehabilitation participants.\\u003csup\\u003e34\\u003c/sup\\u003e However, our results align with existing evidence that physical exercise positively impacts anxiety levels in the elderly.\\u003csup\\u003e35\\u003c/sup\\u003e Additionally, in Thai culture,\\u0026nbsp;families often provide care for older relatives, which may have contributed to the relatively low baseline anxiety scores and improvements over time due to family support and physical recovery.\\u003c/p\\u003e\\n\\u003ch2\\u003eSafety and Adverse Events\\u003c/h2\\u003e\\n\\u003cp\\u003eImportantly, our study did not report any adverse effects or deaths related to the tele-resistance exercise program. One fall occurred in the intervention group; however, it was unrelated to the exercise program and did not result in serious complications. This study underscores the effectiveness of home-based digital health interventions involving communication, feedback, education, and telerehabilitation, which enhance functional outcomes among older patients recovering from hip fractures postsurgery.\\u003csup\\u003e15\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003ch2\\u003eLimitations\\u003c/h2\\u003e\\n\\u003cp\\u003eSeveral limitations must be acknowledged in this study. First, a significant number of patients were excluded due to safety concerns about remote exercise. Since this study was conducted in a tertiary, university-based medical school, the participants may have had more severe health conditions and a higher prevalence of comorbidities compared to those in community-based hospitals. Consequently, the findings may not be applicable to patients in such settings. Second, the relatively small sample size limits the generalizability of the results. This small sample size was partly due to recruitment challenges toward the end of 2022. During this period, many caregivers who were proficient in using smart devices and the LINE video call application had to resume on-site work, reducing their availability to support patients in the telerehabilitation program. Then some of the participants were institutionalized during this time, further limiting the pool of eligible participants.\\u0026nbsp;Increasing the sample size in future research could enhance the robustness of the findings. Additionally, the current study employed a conventional approach that included an exercise booklet and a home exercise program provided prior to discharge. This approach resulted in reduced therapist interaction for the control group, which may have negatively influenced their physical outcomes. Moreover, the participants in the control group were older and utilized gait aids more frequently compared to those in the intervention group. Previous research has established that older age and reduced walking abilities were associated with diminished functional recovery following hip fractures.\\u003csup\\u003e6, 36\\u003c/sup\\u003e Therefore, it is possible that the control group experienced poorer recovery outcomes than the intervention group. For future studies, the Short Physical Performance Battery (SPPB), which consists of three distinct tests\\u0026mdash;standing balance, gait speed, and chair stand tests\\u0026mdash;should be analyzed to assess the impact of telerehabilitation exercises on each component individually. This approach would facilitate the development of more targeted exercise programs. Finally, investigating the long-term effects of telerehabilitation is crucial for evaluating the sustainability of the observed benefits\\u003c/p\\u003e\"},{\"header\":\"CONCLUSIONS\",\"content\":\"\\u003cp\\u003eTele-resistance exercise programs are feasible and effective alternatives to traditional exercise booklets for improving physical function in elderly patients after hip fracture surgery. Notable benefits are evident after 12 weeks. The programs address the challenges of accessing rehabilitation services and enhance patient outcomes in this demographic. Future research should focus on evaluating the long-term effects and optimizing exercise protocols for telerehabilitation.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eSPPB: short physical performance battery, 2MWT: 2-minute walk test, KE: knee extension, BMI: body mass index\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch4\\u003eEthics approval and consent to participate\\u003c/h4\\u003e\\n\\u003cp\\u003eThe study protocol was approved by the Siriraj Institutional Review Board (Si-671/2564). Written informed consent was obtained from all participants prior to study initiation.\\u003c/p\\u003e\\n\\u003ch4\\u003eConsent for publication\\u003c/h4\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research project is supported by Siriraj Research Development Fund (Managed by Routine to Research: R2R) Grant Number IO-R01635015 Faculty of Medicine Siriraj Hospital, Mahidol University\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePD and JK conceived the study, designed the protocol, analyzed the data, and prepared the manuscript. RY, PC, KK, and TC designed the protocol and assisted with the data collection. AU, EV, VS, and US participated in the study design, and commented on the manuscript. All authors read and approved the final version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to thank Mr. Sutthipol Udompunturak for his assistance with the statistical analyses. \\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eOrive M, Aguirre U, Garc\\u0026iacute;a-Guti\\u0026eacute;rrez S, Hayas CL, Bilbao A, Gonz\\u0026aacute;lez N, et al. Changes in health-related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study. Int J Clin Pract. 2015;69(4):491\\u0026ndash;500. DOI:10.1111/ijcp.12527.\\u003c/li\\u003e\\n \\u003cli\\u003eCaeiro JR, Bartra A, Mesa-Ramos M, Etxebarr\\u0026iacute;a \\u0026Iacute;, Montejo J, Carpintero P, et al. Burden of first osteoporotic hip fracture in Spain: a prospective, 12-month, observational study. Calcif Tissue Int. 2017;100(1):29\\u0026ndash;39. DOI:10.1007/s00223-016-0193-8.\\u003c/li\\u003e\\n \\u003cli\\u003eSing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Miner Res. 2023;38(8):1064-1075. DOI:10.1002/jbmr.4821.\\u003c/li\\u003e\\n \\u003cli\\u003eCharatcharoenwitthaya N, Nimitphong H, Wattanachanya L, Songpatanasilp T, Ongphiphadhanakul B, Deerochanawong C, et al. Epidemiology of hip fractures in Thailand. Osteoporos Int. 2024;35(9):1661-1668. DOI:10.1007/s00198-024-07140-2.\\u003c/li\\u003e\\n \\u003cli\\u003eDyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16(1):158. DOI:10.1186/s12877-016-0332-0.\\u003c/li\\u003e\\n \\u003cli\\u003eTang VL, Sudore R, Cenzer IS, Boscardin WJ, Smith A, Ritchie C, et al. Rates of recovery to pre-fracture function in older persons with hip fracture: an observational study. J Gen Intern Med. 2017;32(2):153-158. DOI:10.1007/s11606-016-3848-2.\\u003c/li\\u003e\\n \\u003cli\\u003eGanczak M, Chrobrowski K, Korzeń M. Predictors of a Change and correlation in activities of daily living after hip fracture in elderly patients in a community hospital in Poland: a six-month prospective cohort study. Int J Environ Res Public Health. 2018;15(1):95. DOI:10.3390/ijerph15010095.\\u003c/li\\u003e\\n \\u003cli\\u003eDai YT, Huang GS, Yang RS, Tsauo JY, Yang LH. Functional recovery after hip fracture: six months\\u0026apos; follow-up of patients in a multidisciplinary rehabilitation program. J Formos Med Assoc. 2002;101(12):846-853. PMID: 12632818.\\u003c/li\\u003e\\n \\u003cli\\u003eHandoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2021 Nov 12;11(11):CD007125. DOI:10.1002/14651858.CD007125.\\u003c/li\\u003e\\n \\u003cli\\u003eFreitas MM, Antunes S, Ascenso D, Silveira A. Outpatient and home-based treatment: effective settings for hip fracture rehabilitation in elderly patients. Geriatrics (Basel). 2021;6(3):83. DOI:10.3390/geriatrics6030083.\\u003c/li\\u003e\\n \\u003cli\\u003eSchroeder HS, Israeli A, Liebergall MI, Or O, Ahmed WA, Paltiel O, et al. Home versus hospital rehabilitation of older adults following hip fracture yields similar patient-reported outcome measures. Inquiry. 2024;61:469580241230293. DOI:10.1177/00469580241230293.\\u003c/li\\u003e\\n \\u003cli\\u003eLee H, Lee SH. Effectiveness of multicomponent home-based rehabilitation in older patients after hip fracture surgery: a systematic review and meta-analysis. J Clin Nurs. 2023;32(1-2):31-48. DOI:10.1111/jocn.16256.\\u003c/li\\u003e\\n \\u003cli\\u003eLin PC, Hung SH, Liao MH, Sheen SY, Jong SY. Care needs and level of care difficulty related to hip fractures in geriatric populations during the post-discharge transition period. J Nurs Res. 2006;14(4):251-60. DOI:10.1097/01.jnr.0000387584.89468.30.\\u003c/li\\u003e\\n \\u003cli\\u003eS\\u0026aacute;nchez-Lozano J, Mart\\u0026iacute;nez-Pizarro S. Efficacy of telerehabilitation programs for patients undergoing hip fracture surgery. systematic review. Rev Asoc Argent OrtopTraumatol 2024;89(4):385-392. DOI:10.15417/issn.1852-7434.2024.89.4.1942.\\u003c/li\\u003e\\n \\u003cli\\u003ePliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson P, Jiraporncharoen W, et al. Characteristics and effects of home-based digital health interventions on functional outcomes in older patients with hip fractures after surgery: systematic review and meta-analysis. J Med Internet Res. 2024;26(2024):e49482. DOI: 10.2196/49482.\\u003c/li\\u003e\\n \\u003cli\\u003ePoungvarin N, Prayoonwiwat N, Devahastin V, Viriyavejakul A. Dementia in Thai stroke survivors: analysis of 212 patients. J Med Assoc Thai 1995;78(7):337-343.\\u003c/li\\u003e\\n \\u003cli\\u003eNestle nutrition institute. Mini nutritional assessment [Internet]. [cited Apr 19, 2022]. Available from https://www.mna-elderlycom/sites/default/files/2021-10/mna-mini-thaipdf.\\u003c/li\\u003e\\n \\u003cli\\u003eFreiberger E, Vreede Pd, Schoene D, Rydwik E, Mueller V, Fr\\u0026auml;ndin K, et al. Performance-based physical function in older community-dwelling persons: a systematic review of instruments. Age Ageing. 2012;41(6):712-721. DOI:10.1093/ageing/afs099.\\u003c/li\\u003e\\n \\u003cli\\u003eConnelly D, Thomas B, Cliffe S, Perry W, Smith R. Clinical utility of the 2-minute walk test for older adults living in long-term care. Physiother Can. 2009;61(2):78\\u0026ndash;87. DOI: 10.3138/physio.61.2.78.\\u003c/li\\u003e\\n \\u003cli\\u003eNilchaikovit T, Lortrakul M, Phisansuthideth U. Development of Thai version of Hospital Anxiety and Depression Scale in cancer patients. J Psychiatr Assoc Thailand. 1996;41:18-30.\\u003c/li\\u003e\\n \\u003cli\\u003eNinlerd C, Dungkong S, Phuangphay G, Amornsupak C, Narkbunnam R. Effect of home-based rehabilitation exercise program for elderly patients with femoral neck fracture after bipolar hemiarthroplasty. Siriraj Med J. 2020;72(4):307-314. DOI:10.33192/Smj.2020.42.\\u003c/li\\u003e\\n \\u003cli\\u003eIBM Corp. Released 2023. IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp\\u003c/li\\u003e\\n \\u003cli\\u003eSuetta C, Magnusson S, Beyer N, Kjaer M. Effect of strength training on muscle function in elderly hospitalized patients. Scand J Med Sci Sports. 2007;17(5):464\\u0026ndash;472. DOI: 10.1111/j.1600-0838.2007.00712.x.\\u003c/li\\u003e\\n \\u003cli\\u003eUnited Nations. Sustainable development goals: goal3 Ensure healthy lives and promote well-being for all at all ages [Internet] [Cited Sep15, 2024]. Available from https://wwwunorg/sustainabledevelopment/health/.\\u003c/li\\u003e\\n \\u003cli\\u003eWicks M, Dennett AM, Peiris CL. Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis. Age and Ageing. 2023;52(11):1-13. DOI:10.1093/ageing/afad207.\\u003c/li\\u003e\\n \\u003cli\\u003eLee SY, Yoon BH, Beom J, Ha YC, Lim JY. Effect of Lower-Limb Progressive Resistance Exercise After Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Am Med Dir Assoc. 2017;18(12):1096.e19-1096.e26. DOI:10.1016/j.jamda.2017.08.021.\\u003c/li\\u003e\\n \\u003cli\\u003ePerera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743-9. DOI:10.1111/j.1532-5415.2006.00701.x.\\u003c/li\\u003e\\n \\u003cli\\u003eLacroix A, Hortob\\u0026aacute;gyi T, Beurskens R, Granacher U. Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: a systematic review and meta-analysis. Sports Med. 2017;47(11):2341-2361. DOI:10.1007/s40279-017-0747-6.\\u003c/li\\u003e\\n \\u003cli\\u003eMendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture. Arch Phys Med Rehabil. 2008;89(4):609-617. DOI: 10.1016/j.apmr.2007.09.036.\\u003c/li\\u003e\\n \\u003cli\\u003eGil-Calvo M, de Paz JA, Herrero-Molleda A, Zecchin A, G\\u0026oacute;mez-Alonso MT, Alonso-Cort\\u0026eacute;s B, et al. The 2-minutes walking test is not correlated with aerobic fitness indices but with the 5-times sit-to-stand test performance in apparently healthy older adults. Geriatrics (Basel). 2024;9(2):43. DOI: 10.3390/geriatrics9020043.\\u003c/li\\u003e\\n \\u003cli\\u003eBeckerman H, Heine M, van den Akker LE, de Groot V. The 2-minute walk test is not a valid method to determine aerobic capacity in persons with multiple sclerosis. NeuroRehabilitation. 2019;45(2):239-245. DOI: 10.3233/NRE-192792.\\u003c/li\\u003e\\n \\u003cli\\u003eDionyssiotis Y, de Le\\u0026oacute;n AO. Sarcopenia and Hip Fractures. J Frailty Sarcopenia Falls. 2024;9(1):1-3. DOI: 10.22540/JFSF-09-001.\\u003c/li\\u003e\\n \\u003cli\\u003eRaymond MJ, Bramley-Tzerefos RE, Jeffs KJ, Winter A, Holland AE. Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Arch Phys Med Rehabil. 2013;94(8):1458-1472. DOI:10.1016/j.apmr.2013.02.022.\\u003c/li\\u003e\\n \\u003cli\\u003eWu WY, Zhang YG, Zhang YY, Peng B, Xu WG. Clinical effectiveness of home-based telerehabilitation program for geriatric hip fracture following total hip replacement. Orthop Surg. 2022;15(2):423-431. DOI: 10.1111/os.13521.\\u003c/li\\u003e\\n \\u003cli\\u003eWu F, Zhang J, Yang H, Jiang J. The effect of physical exercise on the elderly\\u0026apos;s anxiety: based on systematic reviews and meta-analysis. Comput Math Methods Med. 2022;2022:4848290. DOI: 10.1155/2022/4848290\\u003c/li\\u003e\\n \\u003cli\\u003eTakahashi A, Naruse H, Kitade I, Shimada S, Tsubokawa M, Kokubo Y, et al. Functional outcomes after the treatment of hip fracture. PLoS One. 2020;15(7):e0236652. DOI: 10.1371/journal.pone.0236652.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-geriatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bgtc\",\"sideBox\":\"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bgtc/default.aspx\",\"title\":\"BMC Geriatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Elderly, Exercise Therapy, Hip Fractures, Physical Function, Telemedicine, Teleresistance Exericse\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5382513/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5382513/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eHip fractures substantially impair quality of life and functional outcomes in elderly individuals. With incidence rates rising globally and in Thailand, effective rehabilitation strategies are crucial. This study evaluated the feasibility and efficacy of teleresistance exercise programs compared with traditional exercise booklets in elderly patients following hip fracture surgery.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA single-blind, randomized controlled trial was conducted. Elderly patients aged 60 to 90 years who had undergone hip fracture surgery were randomized into two groups. The intervention group received a 12-week teleresistance exercise program, whereas the control group followed an exercise booklet. The primary outcome was the short physical performance battery (SPPB). The secondary outcomes were the two-minute walk test (2MWT) score, knee extension strength, and anxiety level.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThirty-three participants with a mean age of 76.8 years (SD 8.6) were enrolled. At 12 weeks, the intervention group presented significant improvements in SPPB scores compared with those of the control group (P\\u0026thinsp;=\\u0026thinsp;0.040). There were no significant differences in 2MWT, knee extension strength or anxiety scores between the groups. The improvements in SPPB and 2MWT scores for the intervention group surpassed the minimal clinically important difference.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eCompared with traditional exercise booklets, teleresistance exercise programs significantly enhance physical function in elderly patients following hip fracture surgery. This method offers a feasible and effective alternative to standard rehabilitation approaches. Future research should explore long-term effects and refine exercise protocols for telerehabilitation.\\u003c/p\\u003e\\u003ch2\\u003eTrial registration:\\u003c/h2\\u003e \\u003cp\\u003eThai Clinical Trials Registry (TCTR20220123001/ 2022-01-21)\\u003c/p\\u003e\",\"manuscriptTitle\":\"Feasibility and Efficacy of Real-time Teleresistance Exercise Programs for Physical Function in Elderly Patients After Hip Fracture Surgery: A Randomized Controlled Trial\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-12-11 14:10:03\",\"doi\":\"10.21203/rs.3.rs-5382513/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-05-20T09:37:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-05-03T18:35:16+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"175881489981583808468997863410185880396\",\"date\":\"2025-05-03T18:13:34+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"232093545492692910985622147288845790001\",\"date\":\"2025-03-04T11:15:13+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"314478352983248363650467364029531016491\",\"date\":\"2025-02-27T11:24:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-01-26T14:58:26+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"157419325445142559868589534071009814150\",\"date\":\"2025-01-09T15:33:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"223477189199337034083868540408827264754\",\"date\":\"2025-01-05T23:13:03+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"193015168400233473041308923961059937101\",\"date\":\"2025-01-05T15:23:16+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-01-03T15:16:36+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2024-11-11T10:59:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-11-08T12:02:49+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-11-08T12:02:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Geriatrics\",\"date\":\"2024-11-03T14:24:34+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-geriatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bgtc\",\"sideBox\":\"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bgtc/default.aspx\",\"title\":\"BMC Geriatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"1cce9c89-d3b2-4d33-a4f2-f99741a8e3f3\",\"owner\":[],\"postedDate\":\"December 11th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-08-25T16:39:14+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5382513\",\"link\":\"https://doi.org/10.1186/s12877-025-06230-y\",\"journal\":{\"identity\":\"bmc-geriatrics\",\"isVorOnly\":false,\"title\":\"BMC Geriatrics\"},\"publishedOn\":\"2025-08-20 16:30:32\",\"publishedOnDateReadable\":\"August 20th, 2025\"},\"versionCreatedAt\":\"2024-12-11 14:10:03\",\"video\":\"\",\"vorDoi\":\"10.1186/s12877-025-06230-y\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12877-025-06230-y\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5382513\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5382513\",\"identity\":\"rs-5382513\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}