Who Will Walk Again? Effects of Rehabilitation on the Ambulatory Status in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture

Abstract

Introduction:Femoral neck fractures in elderly patients result in significant reduction in mobility. Deconditioning takes place quickly without early ambulation postsurgery. A recent Cochrane review found inconclusive evidence on the rehabilitation protocol required to effectively restore patients’ prefracture mobility status. This study was conducted to determine the effects of different rehabilitation approaches on the functional and mobility outcomes of elderly patients after hip hemiarthroplasty for femoral neck fractures.Materials and Methods:We enrolled consecutive patients aged >65 years, admitted into a tertiary orthopedic unit from January to December 2010, who had undergone hip hemiarthroplasty. They were divided into 3 cohorts: (a) home with outpatient rehabilitation, (b) intensive short rehabilitation, and (c) extended slow-stream rehabilitation. Clinical variables were collected along with outcome variables of Modified Harris Hip Score, Parker Mobility Score (PMS), and the return to near premorbid ambulatory status at 1 year (PMS decrease of ≤2).Results:A total of 133 patients were recruited and followed up for a year. The 3 cohorts were found to be comparable for prefall cardiovascular diseases, PMS, and Katz Index, although it was found that in the slow-stream cohort, there was a greater percentage of patients with previous cerebrovascular accidents. Patients in the intensive short rehabilitation cohort were found to have a higher proportion of patients returning to prefracture mobility, with the odds ratio of 2.3478 (95% confidence interval: 1.0667 to 5.1674; P = .042) after multivariate analysis.Conclusions:Elderly patients >65 years who had undergone hemiarthroplasty would likely benefit most from an intensive inpatient rehabilitation program.

Patient Perspectives on Engagement in Recovery after Hip Fracture: A Qualitative Study

“…It is well understood that the integration of ambulatory and progressive rehabilitation programming into a postfracture care plan is necessary for improving patient strength, balance, and functional independence in completing activities of daily living [16, 33]. Programs that utilize elements of both types of rehabilitation programs, such as coupling the delivery of a short-term, inpatient program with a long-term, progressive outpatient program for up to 4–6 months with an integrated balance, and strength component, may offset declines in patient adherence and produce the best functional outcomes [16, 20, 24, 40, 41]. We support a model that includes sustained engagement.…”

Preoperative Anemia, Functional Outcomes, and Quality of Life After Hip Fracture Surgery

“…The PMS is a scale from 0 to 9, summating scores on 3 questions about mobility . It reflects an individual's independence, is widely used to assess function after hip surgery, and has been validated for use in Singapore …”

Slow Stream Rehabilitation for Older Adults: A Scoping Review

“…After initial and full text review, we included 21 primary articles and grey literature documents: 11 peer-reviewed articles, five conference abstracts, and five report documents. Three documents (Englund, 1987;Raymond, Winter, & Holland, 2015;Wilson & Ballentyne, 2017) did not describe the SSR program or outcomes of the program, and therefore we later excluded them in the data extraction phase: (a) one of the three excluded documents was a measurement study aimed at validating an activity monitor in a hospital-based SSR setting (Raymond, Winter, & Holland, 2015; peer-reviewed); (b) one of three excluded was a critique of the methodology used in O'Neill et al's 1987 article and a response to the critique in 1987 (Englund, 1987;peer-reviewed); and (c) the last excluded document was a description of the role of occupational therapists in SSR (Wilson & Ballentyne, 2017; The final 18 literature documents were published in four different countries: Australia (O'Neill et al, 1987;Parker, Hill, Cobden, Davidson, & McBurney, 2015;Salgado et al, 1995); Canada (ALC Expert Panel, 2006; Berall, Naglie, Katz, Chang, & Leung, 2013;GTA Rehab Network, 2008;Katz et al, 2013;Kubilius, Rose, Pettit, & St. Amant, 2016;Leung et al, 2014;Leung et al, 2016;Ontario Hospital Association, 2006;Ontario Stroke Network, 2013;South West LHIN, 2009;Teasell, Foley, Bhogal, Chakravertty, & Bluvol, 2005;Tourangeau et al, 2011); Singapore (Chong, Empensando, Ding, & Tan, 2012;Zhang, Ang, & Kwek, 2015); and the Netherlands (Spruit-van Eijk, Zuidema, Buijck, Koopmans, & Geurts, 2012) ( Table 3).…”

“…FIT = functional individual training; N/R = not reported; SSR = slow stream rehabilitation. Berall et al, 2013;GTA Rehab Network, 2008;Katz et al, 2013;Leung et al, 2014;Leung et al, 2016;O'Neill et al, 1987;Ontario Stroke Network, 2013;Ontario Hospital Association, 2006;Parker et al, 2015;Salgado et al, 1995;South West LHIN, 2009;Spruit-van Eijk et al, 2012;Teasell et al, 2005;Zhang et al, 2015) (Table 4) (Berall et al, 2013;Chong et al, 2012;Katz et al, 2013;Kubilius et al, 2016;Leung et al, 2014;Leung et al, 2016;O'Neill et al, 1987;Ontario Stroke Network, 2013;Salgado et al, 1995;South West LHIN, 2009;Spruit-van Eijk et al, 2012;Teasell et al, 2005;Tourangeau et al, 2011;Zhang et al, 2015). Only 10 of 18 (55%) included documents described the SSR session intensity (Berall et al, 2013;GTA Rehab Network, 2008;Katz et al, 2013;Leung et al, 2014;Leung et al, 2016;Parker et al, 2015;Salgado et al,1995;Spruit-van Eijk et al, 2012;Teasell et al, 2005;Tourangeau et al, 2011).…”

“…Four literature documents used a measure of cognitive ability at baseline, and these documents reported that most of the older adult participants had some level of cognitive impairment or delirium (Berall et al, 2013;Katz et al, 2013;Leung et al, 2016;Spruit-van Eijk et al, 2012). Leung et al (2016) reported that 72 per cent of participants had some cognitive impairment, and 83 per cent had some level of delirium (Leung et al, 2016 Kubilius et al, 2016;Leung et al, 2014;Leung et al, 2016;O'Neill et al, 1987;Parker et al, 2015;Salgado et al,1995;Spruit-van Eijk et al, 2012;Teasell et al, 2005;Tourangeau et al, 2011;Zhang et al, 2015). Over three quarters (76.9%, 10 of 13) of the literature documents that used outcome measures used a measure of ADL or function to assess change from baseline to discharge (Berall et al, 2013;Katz et al, 2013;Kubilius et al, 2016;Leung et al, 2014;Leung et al, 2016;O'Neill et al, 1987;Parker et al, 2015;Spruitvan Eijk et al, 2012;Teasell et al, 2005;Tourangeau et al, 2011).…”