Rehabilitation Following Hip Fracture

Excerpt

After a hip fracture operation, an older person’s recovery is enhanced if they are provided with an optimistic, well-coordinated rehabilitation programme. A rehabilitation approach should start as early as possible to prevent functional decline and complications and ideally include a multidisciplinary team (physiotherapy, occupational therapy, nutrition, social work, psychology and medicine) with the integration of orthogeriatric and rehabilitation services. The team should meet regularly, set goals with the patient and family, provide appropriate treatments, review progress towards the goals and assess outcomes. In countries where these particular multidisciplinary specialists are not available, professionals with these competencies should strive to achieve the same recovery outcomes which include avoiding weight loss, recovering walking ability, self-confidence and independence. A key focus of rehabilitation is early mobilisation, with higher doses of mobility training associated with better outcomes. The physiotherapy aspect of in-patient rehabilitation programmes should include goal-directed mobilisation practice with balance and functional exercises. Rehabilitation programmes should begin soon after hospital admission and continue after hospital discharge. Benefit has also been demonstrated in patients with cognitive impairment so these patients should not be excluded from rehabilitation programmes. Where teams are not available, elements of this approach can be included in a care pathway developed with patients and families. This chapter outlines evidence-based recommendations for the key elements of rehabilitation programmes. Suggested implementation strategies based on expert opinion for low- and middle-income countries (LMICs) are also provided.