Association between Acute Postoperative Pain and Recovery of Independent Walking Ability after Surgical Treatment of Hip Fracture

Abstract

Objective: The intensity of pain after surgical treatment of hip fracture has a negative effect on functional recovery. However, the effects of acute postoperative pain on the recovery of walking ability after the surgery remain unclear. This study aimed to investigate the association between acute postoperative pain and the recovery of functional gait among patients who had independent walking ability prior to hip fracture. Methods: This was an observational study that included 41 patients with a mean age of 81.3±7.3 years who underwent surgical treatment for traumatic hip fracture at a general hospital. The primary outcome was the time to recovery of independent gait postsurgery. Based on the median time to recovery, patients were classified into an early independent walking group and an independent walking group. Stepwise logistic regression analysis was performed to identify predictive factors of the time to recovery of independent walking. Results: The median time to recovery of independent gait was 24 days (range, 7-50 days). In total, 20 patients were classified in the early independent walking group and 21 in the independent walking group. On logistic regression analysis, the total pain intensity, reported during activities of daily living (ADL) on postoperative days 5 and 6, and the knee extensor strength were predictive of the time to recovery of independent walking. Conclusions: The degree of recovery of gait function of patients surgically treated for hip fracture was found to be predicted by the pain intensity measured during ADL and the knee extensor strength assessed in the acute phase. Effective management of acute pain after surgical treatment of hip fracture may help improve functional recovery of gait.

Important perioperative factors, guidelines and outcomes in the management of hip fracture

“…Using extensive pain management as a substitute for early surgery should also be avoided. Analgesia use in the postoperative period follows the same general principles and is paramount to enabling patients to mobilise as part of their rehabilitation ( Hida et al 2018 ).…”

Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial

“… 7 These factors can exacerbate pain, 6 leading to delayed decreased mobility and lower participation in rehabilitation. 8 As rehabilitation activities decreases, there is an associated increase in fear of falling, linked to lower social participation. 9 Collectively, these factors contribute to a negative and generalised impact on the quality of life after a hip fracture.…”