No Rest for the Wounded: Early Ambulation After Hip Surgery Accelerates Recovery

Oldmeadow, Leonie B; Edwards, Elton; Kimmel, Lara A; Kipen, Eva; Robertson, Val J.; Bailey, Michael

doi:10.1111/j.1445-2197.2006.03786.x

Cited by 214 publications

(194 citation statements)

References 14 publications

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“…However, this affected clinical practice and resources (Tsauo et al, 2005). Oldmeadow et al (2006) compared the effects of early mobilisation against delayed ambulation post-operatively. Early ambulation promoted functional recovery with an increased discharge rate to the home environment and reduced the need for higher level of care.…”

Section: Professional Focusmentioning

confidence: 99%

Older adult’s recovery from hip fracture: A literature review

Healee

McCallin

Jones

2011

International Journal of Orthopaedic and Trauma Nursing

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This paper examines studies on older adult's recovering from hip fracture and views these in relation to practice. A metasearch engine was used to access health databases to identify studies relevant to recovery from hip fracture that occurs predominantly in the older adult. Three themes emerged: professional; quality of life, and ageing status.Results suggest recovery has a predominant functional restorative focus although recovery outcome is also influenced by physical function and psychosocial factors.Results suggest that the patient-centric approach has been lost in the drive for organisational efficiency has potentially driven care delivery, which has emphasised safer interventions and improved programmes. This has reduced complications and shortened length of stay in hospital but the psychosocial factors that have a long-term affect on recovery have been lost altogether. Investigating the patient-centric approach to care for older adults recovering from hip fracture is required to balance the organisational efficiency within healthcare systems. Mental health recovery models may provide such a framework to review the patient focused approach.2

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Section: Professional Focusmentioning

confidence: 99%

Older adult’s recovery from hip fracture: A literature review

Healee

McCallin

Jones

2011

International Journal of Orthopaedic and Trauma Nursing

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“…The review included a total of 22,443 patients and 97 health professionals. In total, 6282 (range 90-401) patients participated in RCTs, 12,69,78,80,87,[128][129][130]197,199 276 (range 24-95) patients participated in quasi-RCTs, 83,[131][132][133] 116 (range 20-30) patients participated in non-RCTs, 79,[134][135][136][137] 3044 (range 1-919) patients participated in historical cohort studies, 13,[157][158][159][160][161][162][163][164][165]170,173,178 7136 (range 18-946) patients participated in concurrent cohort studies, 81,[138][139][140][141][142][143][144][145][146][147][148][149][150][151][152]169,177,179,…”

Section: Summary Of Participant Characteristicsmentioning

confidence: 99%

“…185 Eight studies included patients aged ≥ 50 years; 87,98,103,118,173,187,188,192 18 studies included patients aged ≥ 60 years; 12,89,96,104,114,117,119,122,132,133,149,154,164,[193][194][195][196][197] 19 studies included patients aged ≥ 70 years; 69,72,79,88,106,108,110,111,116,120,131,136,143,148,150,161,180,183,184 and seven studies included patients aged ≥ 80 years. 13,81,123,134,137,152,178 The age of the included participants could not be determined from the study reports for four studies.…”

Section: A Community-based Multidisciplinary Rehabilitation Package Fmentioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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“…30 Early mobilization within 2 days after surgery to repair a hip fracture has been demonstrated to improve patient mobility and increase the likelihood of patients being discharged directly home. 31 However, a Cochrane review assessing mobilization strategies following hip fracture surgery in adults concluded that the evidence base for effective rehabilitation strategies is limited, with no one mobilization strategy emerging as the preferred treatment. 32 It has been suggested that the success of hospital-based rehabilitation programmes depends upon the co-ordination of multidisciplinary teams consisting of experts in a variety of medical, allied-health, social and educational fields.…”

Section: Rehabilitation Programmesmentioning

confidence: 99%

Maintaining independence after a fall

Spinks

Wasiak

2009

Rev. Clin. Gerontol.

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SummaryFalls have a significant impact upon independent living ability in older people, with fall-related fractures one of the leading predictors of having to move into assisted living facilities. The loss of independence associated with a severe fall is often accompanied by a decline in physical, social, emotional and economic well-being. Rehabilitation programmes to restore functional ability following a fall have a greater chance of success if they adopt a multi-disciplinary approach and, if appropriate, are conducted in the patient's own home. Additional multi-component interventions that improve confidence and reduce the risk of subsequent falls may confer benefits by assisting individuals independently to perform activities of daily living.

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No Rest for the Wounded: Early Ambulation After Hip Surgery Accelerates Recovery

Abstract: EA after hip fracture surgery accelerates functional recovery and is associated with more discharges directly home and less to high-level care.

Cited by 214 publications

References 14 publications

Older adult’s recovery from hip fracture: A literature review

Older adult’s recovery from hip fracture: A literature review

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Maintaining independence after a fall

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