A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

Abstract

Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. Objective To identify if there is an evidence to practice gap in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery. Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included. Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment. Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

A hospital based clinical observational study to evaluate the functional recovery and risks of not regaining to the pre-fracture mobility level in elderly patients with hip fractures

“…Research has demonstrated that early mobilization can reduce the duration of hospitalization and assist in restoring a patient's functional abilities, enabling them to return to their living situation prior to the fracture [4] . Recent studies indicate that the elderly population, who were able to walk before their fracture, spend more than 80% of their time in bed while hospitalized [7][8][9][10] . In 2011, a group of healthcare professionals at a major urban hospital in Toronto, Ontario, introduced the Bone & Joint National Model for Hip Fracture Care & Toolkit (2011) on a single unit dedicated to post-operative care.…”

“…The Hip Fracture Care & Toolkit was created with the aim of establishing and spreading the most effective methods for treating hip fractures throughout all provinces in Canada. 6 An analysis of the hip fracture population among older adults in this unit [10] revealed that early mobility activities are commenced within the first five days following surgery, with varying levels of implementation. A significant number of patients chose not to engage in early mobility activities, particularly among those with a low pre-fracture functional mobility level and those with cognitive impairment.…”