Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

doi:10.5535/arm.21110

. 2021 Jun;45(3):225-259.

doi: 10.5535/arm.21110. Epub 2021 Jun 30.

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

Kyunghoon Min¹, Jaewon Beom², Bo Ryun Kim³, Sang Yoon Lee⁴, Goo Joo Lee⁵, Jung Hwan Lee⁶, Seung Yeol Lee⁷, Sun Jae Won⁸, Sangwoo Ahn⁹, Heui Je Bang¹⁰, Yonghan Cha¹¹, Min Cheol Chang¹², Jung-Yeon Choi¹³, Jong Geol Do¹⁴, Kyung Hee Do¹⁵, Jae-Young Han¹⁶, Il-Young Jang¹⁷, Youri Jin¹⁸, Dong Hwan Kim¹⁹, Du Hwan Kim²⁰, In Jong Kim²¹, Myung Chul Kim²², Won Kim²³, Yun Jung Lee²⁴, In Seok Lee²⁵, In-Sik Lee²⁶, JungSoo Lee²⁷, Chang-Hyung Lee²⁸, Seong Hoon Lim²⁹, Donghwi Park³⁰, Jung Hyun Park³¹, Myungsook Park³², Yongsoon Park³³, Ju Seok Ryu², Young Jin Song³⁴, Seoyon Yang³⁵, Hee Seung Yang¹⁵, Ji Sung Yoo³⁶, Jun-Il Yoo³⁷, Seung Don Yoo¹⁹, Kyoung Hyo Choi²³, Jae-Young Lim²

Affiliations

¹ Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
² Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
³ Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
⁴ Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
⁵ Department of Rehabilitation Medicine, Seoul National University Hospital, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.
⁶ Namdarun Rehabilitation Clinic, Yongin, Korea.
⁷ Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
⁸ Department of Rehabilitation Medicine, Yeouido Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
⁹ Physical Therapy, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁰ Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea.
¹¹ Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
¹² Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea.
¹³ Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
¹⁴ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁵ Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
¹⁶ Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea.
¹⁷ Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
¹⁸ Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea.
¹⁹ Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
²⁰ Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
²¹ Howareyou Rehabilitation Clinic, Seoul, Korea.
²² Department of Physical Therapy, Eulji University, Seongnam, Korea.
²³ Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²⁴ Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea.
²⁵ Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea.
²⁶ Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea.
²⁷ Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
²⁸ Department of Physical Medicine and Rehabilitation, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
²⁹ Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
³⁰ Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
³¹ Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.
³² Department of Nursing, Konkuk University, Chungju, Korea.
³³ Department of Food and Nutrition, Hanyang University, Seoul, Korea.
³⁴ Occupational Therapy, Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea.
³⁵ Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
³⁶ Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
³⁷ Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.

PMID: 34233406
PMCID: PMC8273721
DOI: 10.5535/arm.21110

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

Kyunghoon Min et al. Ann Rehabil Med. 2021 Jun.

. 2021 Jun;45(3):225-259.

doi: 10.5535/arm.21110. Epub 2021 Jun 30.

Authors

Affiliations

¹ Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
² Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
³ Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
⁴ Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
⁵ Department of Rehabilitation Medicine, Seoul National University Hospital, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.
⁶ Namdarun Rehabilitation Clinic, Yongin, Korea.
⁷ Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
⁸ Department of Rehabilitation Medicine, Yeouido Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
⁹ Physical Therapy, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁰ Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea.
¹¹ Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
¹² Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea.
¹³ Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
¹⁴ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁵ Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
¹⁶ Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea.
¹⁷ Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
¹⁸ Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea.
¹⁹ Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
²⁰ Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
²¹ Howareyou Rehabilitation Clinic, Seoul, Korea.
²² Department of Physical Therapy, Eulji University, Seongnam, Korea.
²³ Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²⁴ Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea.
²⁵ Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea.
²⁶ Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea.
²⁷ Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
²⁸ Department of Physical Medicine and Rehabilitation, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
²⁹ Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
³⁰ Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
³¹ Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.
³² Department of Nursing, Konkuk University, Chungju, Korea.
³³ Department of Food and Nutrition, Hanyang University, Seoul, Korea.
³⁴ Occupational Therapy, Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea.
³⁵ Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
³⁶ Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
³⁷ Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.

PMID: 34233406
PMCID: PMC8273721
DOI: 10.5535/arm.21110

Abstract

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries.

Methods: Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method.

Results: A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost.

Conclusion: This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Keywords: Community Health Services; Hip fractures; Patient Care Team; Practice Guideline; Rehabilitation.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

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References

1. Lee YK, Kim JW, Lee MH, Moon KH, Koo KH. Trend in the age-adjusted incidence of hip fractures in South Korea: systematic review. Clin Orthop Surg. 2017;9:420–3. - PMC - PubMed
1. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7:407–13. - PubMed
1. Kang HY, Yang KH, Kim YN, Moon SH, Choi WJ, Kang DR, et al. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health. 2010;10:230. - PMC - PubMed
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[1] Lee YK, Kim JW, Lee MH, Moon KH, Koo KH. Trend in the age-adjusted incidence of hip fractures in South Korea: systematic review. Clin Orthop Surg. 2017;9:420–3. - PMC - PubMed

[2] Lee YK, Kim JW, Lee MH, Moon KH, Koo KH. Trend in the age-adjusted incidence of hip fractures in South Korea: systematic review. Clin Orthop Surg. 2017;9:420–3. - PMC - PubMed

[3] Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7:407–13. - PubMed

[4] Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7:407–13. - PubMed

[5] Kang HY, Yang KH, Kim YN, Moon SH, Choi WJ, Kang DR, et al. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health. 2010;10:230. - PMC - PubMed

[6] Kang HY, Yang KH, Kim YN, Moon SH, Choi WJ, Kang DR, et al. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health. 2010;10:230. - PMC - PubMed

[7] Zuckerman JD. Hip fracture. N Engl J Med. 1996;334:1519–25. - PubMed

[8] Zuckerman JD. Hip fracture. N Engl J Med. 1996;334:1519–25. - PubMed

[9] Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin Geriatr Med. 2014;30:229–41. - PubMed

[10] Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin Geriatr Med. 2014;30:229–41. - PubMed

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Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

Affiliations

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

Authors

Affiliations

Abstract

Conflict of interest statement

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