Hip fractures are a substantial problem in Australia in the ageing population. They are most common in people aged 65 year and over and cause a large number of hospitalisations each year, increased risk of death and disability and place a significant financial burden on the healthcare system.

The health and financial burdens continue after patients with hip fracture are discharged from hospital with increased immobility and reduced capacity to perform daily living activities. There is also increased risk of rehospitalisation.

Optimal management of hip fracture patients post surgery is important to try to reduce the adverse outcomes associated with the injury and minimise the risk of readmission.

Various rehabilitation strategies have been trialled with varying intensities and results.

While there are guidelines for the management of people with hip fractures, there are minimal recommendations about the optimal intensity of rehabilitation during the acute post-operative period. Australian researchers investigated the efficacy of an intensive physiotherapy program for patients aged 65 years and over with isolated hip fractures, after they’d had surgery.

Patients were 65 years and older being treated in a trauma centre in Melbourne.

Inclusion criteria included having been admitted to hospital with an isolate subcapital or intertrochanteric hip fracture and being treated with internal fixation (surgical implementation of implants to repair the bone) or hemiarthroplasty (surgical procedure that replaces the ball portion of the hip joint with a prosthesis).

Participants were assigned to receive either usual care, a 30 minute physiotherapy session seven days a week; or intensive physiotherapy which involved usual care, an additional physiotherapy session each day and another session delivered by an allied health assistant.

Outcomes assessed included functional capacity, mobility, acute hospital length of stay and readmissions.

People receiving the intensive physiotherapy had a reduction of more than 10 days in hospital stay compared to those receiving usual care, without increasing rates of complication and readmission.

There were no statistically significant differences in functional mobility observed between the two groups.

Implications

This research supports the benefits of physiotherapy for older people who’ve had surgery for a hip fracture.

Less time in hospital and a quicker return to home could provide important improvements to patients’ quality of life and also substantial financial savings.

Talk to a specialist for good advice on evidence-based programs to best suit your circumstances.

Last Reviewed: 10/10/2019

© Norman Swan Medical Communications.



References

Kimmel, L et al. HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial. MJA doi: 10.5694/mja16.00091.