Effectiveness of C-Mill training following hip fracture.

Thirty percent of all community-living people over 65 years of age fall each year and fall incidence is even higher in older populations, in nursing, rehabilitation and hospital care facilities and in elderly who previously experienced an injurious fall.
Most falls are caused by trips and slips during walking and often external factors, like obstacles, are involved. Gait-related falls are thus very common events in elderly and put a large strain on the health and well-being of older adults.
Safe gait requires continuous step adjustments in order to, for example, negotiate in uneven terrain or to avoid obstacles. Earlier research reported that the ability to adjust gait during walking is often impaired in elderly. C-Mill training is
specifically developed to practice stepadjustments during walking. The effectiveness of C-Mill training, i.e. treadmill walking with a specific emphasis on functional walking ability via constant and irregular gait modulations, obstacle crossing and speeding-up and slowing-down, on walking ability, fall incidence and fear of falling has not been studied thus far.



The aim of this study is to examine the effectiveness of C-Mill training over other training for improving walking ability in elderly recovering from a fall-related hip fracture. Secondary objective is to examine the effectiveness of C-Mill
training, compared to other training, for reducing fall incidence and fear of falling.



Walking ability, fall incidence and fear of falling in a group of participants receiving 6 weeks of C-Mill training, will be compared with that of two control groups receiving either 6 weeks of dose-matched treadmill walking without a focus on training gait adjustments or dose-matched conventional physiotherapy. It is hypothesized that C-Mill training is superior to regular treadmill walking and conventional physiotherapy in improving walking ability and reducing fall incidence and fear of falling.

Falls are common in elderly and often result in adverse consequences. The effectiveness of C-Mill training, i.e. treadmill walking with a specific emphasis on functional walking ability via constant and irregular gait modulations, obstacle crossing and speeding-up and slowing-down, on walking ability, fall incidence and fear of falling has not been studied thus far.

It is hypothesized that C-Mill training is superior to regular treadmill walking and conventional physiotherapy in improving walking ability and reducing fall incidence and fear of falling in elderly residing in inpatient rehabilitation care after a fall-related hip fracture.

1. Pre-intervention (week 1);

2. Post - intervention (week 7);

3. Retention (4 weeks post-intervention);

4. 12 month follow-up;

5. Fall incidence is monitored monthly for a period of 1 year.

1. C-Mill training, i.e. treadmill training with a specific emphasis on training gait adaptability: 2-3 times a week 40 minutes in groups of 2 patients for 6 consecutive weeks. The C-Mill training sessions are supplemented with conventional physiotherapy to a frequency of 5 times a week;

2. Regular treadmill training : 2-3 times a week 40 minutes in groups of 2 patients for 6 consecutive weeks. Treadmill training sessions are supplemented with conventional physiotherapy to a frequency of 5 times a week;

3. Control group: Conventional physiotherapy, 5 times a week for 6 consecutive weeks.



Dose-matched control groups:

C-Mill and treadmill training sessions replace a similar dose of conventional therapy to create dose-matched control groups, i.e. all groups receive therapy with equal duration and frequency.