Observational Study

. 2024 Jul 23;24(1):629.

doi: 10.1186/s12877-024-05206-8.

Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study

Daniel Siminiuc¹, Oya Gumuskaya¹, Rebecca Mitchell², Jack Bell³, Ian D Cameron⁴, Jamie Hallen⁵, Karen Birkenhead^{1

6}, Sarah Hurring⁷, Brett Baxter⁸, Jacqueline Close^{5

9}, Katie J Sheehan¹⁰, Antony Johansen¹¹, Mellick J Chehade¹², Catherine Sherrington^{13

14}, Zsolt J Balogh¹⁵, Morag E Taylor⁵, Mitchell Sarkies^{16

17

18}

Affiliations

¹ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia.
² Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia.
³ Allied Health Research Collaborative, The Prince Charles Hospital, QLD, 4032, Chermside, Australia.
⁴ Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health Districtand, University of Sydney, NSW, 2064, St Leonards, Australia.
⁵ Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia.
⁶ Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia.
⁷ Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand.
⁸ Physiotherapy Department, Princess Alexandra Hospital, QLD, 4102, Woolloongabba, Australia.
⁹ School of Clinical Medicine, University of New South Wales, NSW, 2052, Sydney, Australia.
¹⁰ Bone & Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
¹¹ School of Medicine, University Hospital of Walesand, Cardiff University, Cardiff, UK.
¹² Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia.
¹³ Institute for Musculoskeletal Health, The University of Sydneyand, Sydney Local Health District, Gadigal Land, NSW, 2006, Sydney, Australia.
¹⁴ Sydney School of Public Health and, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Gadigal Land, NSW, 2006, Sydney, Australia.
¹⁵ Department of Traumatology, Trauma and Injury Research Program, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, NSW, Newcastle, Australia.
¹⁶ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia. mitchell.sarkies@sydney.edu.au.
¹⁷ Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia. mitchell.sarkies@sydney.edu.au.
¹⁸ Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia. mitchell.sarkies@sydney.edu.au.

PMID: 39044173
PMCID: PMC11264512
DOI: 10.1186/s12877-024-05206-8

Observational Study

Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study

Daniel Siminiuc et al. BMC Geriatr. 2024.

. 2024 Jul 23;24(1):629.

doi: 10.1186/s12877-024-05206-8.

Authors

Affiliations

¹ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia.
² Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia.
³ Allied Health Research Collaborative, The Prince Charles Hospital, QLD, 4032, Chermside, Australia.
⁴ Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health Districtand, University of Sydney, NSW, 2064, St Leonards, Australia.
⁵ Neuroscience Research Australia, University of New South Wales, NSW, 2031, Randwick, Australia.
⁶ Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia.
⁷ Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand.
⁸ Physiotherapy Department, Princess Alexandra Hospital, QLD, 4102, Woolloongabba, Australia.
⁹ School of Clinical Medicine, University of New South Wales, NSW, 2052, Sydney, Australia.
¹⁰ Bone & Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
¹¹ School of Medicine, University Hospital of Walesand, Cardiff University, Cardiff, UK.
¹² Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia.
¹³ Institute for Musculoskeletal Health, The University of Sydneyand, Sydney Local Health District, Gadigal Land, NSW, 2006, Sydney, Australia.
¹⁴ Sydney School of Public Health and, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Gadigal Land, NSW, 2006, Sydney, Australia.
¹⁵ Department of Traumatology, Trauma and Injury Research Program, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, NSW, Newcastle, Australia.
¹⁶ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Level 7 D18Western Avenue NSW 2006, Camperdown, Australia. mitchell.sarkies@sydney.edu.au.
¹⁷ Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Sydney, Australia. mitchell.sarkies@sydney.edu.au.
¹⁸ Implementation Science Academy, Sydney Health Partners, NSW, Camperdown, Australia. mitchell.sarkies@sydney.edu.au.

PMID: 39044173
PMCID: PMC11264512
DOI: 10.1186/s12877-024-05206-8

Abstract

Purpose: To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture.

Methods: A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders.

Results: Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5-13) and 20 (IQR 8-38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2-3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2-3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02).

Conclusion: Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS.

Keywords: Ambulation; Audit; Clinical quality registry; Fracture neck of femur; Key performance indicator; Orthogeriatric; Perioperative care; Physiotherapy; Recovery; Walking.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Study flowchart count of exposure and outcome. ^aIncludes unit in a retirement village. ^b Excludes missing observations from confounders

See this image and copyright information in PMC

References

1. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458–60. 10.1016/j.injury.2018.04.015 - DOI - PubMed
1. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55(9):M498-507. 10.1093/gerona/55.9.M498 - DOI - PubMed
1. Parker M, Johansen A. Hip fracture. BMJ. 2006;333(7557):27–30. 10.1136/bmj.333.7557.27 - DOI - PMC - PubMed
1. Dyer 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. 10.1186/s12877-016-0332-0 - DOI - PMC - PubMed
1. Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R, et al. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults >/= 65 years living with and without dementia: a population-based cohort study. Osteoporos Int. 2020;31(3):465–74. 10.1007/s00198-019-05260-8 - DOI - PubMed

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Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study

Affiliations

Rehabilitation after surgery for hip fracture - the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials