A case series of patients change in mobility following a hip fracture

Early Mobilization and Predictors of Delayed Disposition for Geriatric Hip Fractures

OBJECTIVES

To evaluate the effect of perioperative variables, including physical therapy (PT) and walking distance on length of stay (LOS) in hip fracture patients.

METHODS

DESIGN

A retrospective review.

SETTING

Single level I trauma center.

PATIENT SELECTION CRITERIA

Patients aged 65 years and above with hip fractures Orthopaedic Trauma Association/AO Foundation 31-A and 31-B) between 2017 and 2020 were included. Patients were excluded if they were treated nonoperatively, suffered periprosthetic fracture, or were not admitted under the hip fracture protocol.

OUTCOME MEASURES AND COMPARISONS

Admission and perioperative variables including time to surgery and number of postoperative days (PODs) without a documented PT session during the first 3 PODs were assessed for correlation with increased total hospital LOS and postoperative LOS.

RESULTS

There were 301 patients included [234 (77.7%) female] with an average age of 84.4 years (±8.1 years). The median total LOS was 5 (interquartile range, 3-7) days and 4 (interquartile range 3-6) days after surgical fixation. Thirty-seven percentage of hip fractures had a delay in discharge. Ninety-five percentage of patients were discharged to a rehabilitation facility. The highest percentage of days with no PT session occurred on Saturdays and Sundays with 43% and 34% on POD 1, respectively; 40% and 33% on POD 2; and 26% and 30% on POD 3; P = 0.0004. In multivariate analysis, longer total LOS was associated with time to surgery more than 24 hours [AOR 5.6; 95% confidence interval (CI), 1.8-17.4; P < 0.0030], major complication (AOR 8.26; 95% CI, 2.8-20.0; P < 0.0014), discharge to subacute rehab (AOR 5.6; 95% CI, 3.0-10.5; P < 0.0001), and walking < 5 feet or not receiving PT (among patients with no assistance required as prehospital ambulatory status) (AOR 6.0; 95% CI, 2.3-15.3; P < 0.02). Longer LOS after surgery was associated with major complication (AOR 11.2; 95% CI, 3.1-39.8; P < 0.0002), discharge to subacute rehab (AOR 5.0; 95% CI, 2.7-9.1; P < 0.0001), and walking < 5 feet or no PT (AOR 4.8; 95% CI, 2.0-11.5; P < 0.01).

CONCLUSIONS

Emphasis should be placed on minimizing complications while maximizing postoperative PT and early ambulation in the acute postoperative period, given the demonstrated association between inadequate mobilization and delayed disposition, especially if surgical fixation occurs surrounding the weekend or holiday.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study

Background

After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand.

Objective

This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery.

Methods

A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis.

Results

The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001).

Conclusion

The study's results provide valuable insights for nurses to target these modifiable factors to enhance patients' mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

Effect of Early Mobilization on Hip and Lower Extremity Postoperative: A Literature Review

INTRODUCTION

The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest can potentially increase the incidence of various complications that may increase patients' morbidity and mortality rate after hip and lower extremities surgery. This literature review aimed to identify the effects of early mobilization on hip and lower extremity postoperative.

METHODS

Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online, and Scopus, using the Boolean operator tools with "AND" and "OR" words by combining several keywords according to the literature review topic, with inclusion criteria of those published in the last three years (2019-2021), using a quantitative design, written in English and full-text articles. A total of 435 articles were obtained, screened, and reviewed so that there were 16 (sixteen) eligible articles.

RESULTS

There were 11 (eleven) effects of early mobilization, that is, shorter the length of stay, lower postoperative complication, lower the pain, increase walking ability, increase quality of life, decrease the rate of readmission, decrease mortality rate, lower the total hospitalization cost, higher number of physical therapy sessions prior to discharge, increase in satisfaction, and no fracture displacement or implant failure.

CONCLUSION

This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients can implement early mobilization and motivate patients to cooperate in undergoing early mobilization.

Participating in the Illness Journey: Meanings of Being a Close Relative to an Older Person Recovering from Hip Fracture-A Phenomenological Hermeneutical Study

When an older person suffers an acute event, such as a hip fracture, it influences the whole family. Research shows that while close relatives want to be a part of the older person's life during recovery it is associated with a high perceived level of stress and burden. To provide in-depth knowledge of close relatives' experiences in this situation, the aim of this study was to elucidate meanings of being a close relative to an older person recovering from hip fracture surgery.This study has a qualitative descriptive phenomenological hermeneutical design. Narrative interviews were conducted with ten close relatives. Analysis was conducted using phenomenological hermeneutical interpretation which provided a deeper understanding of the close relatives' lived experiences of their older person's recovery from hip fracture surgery. The structural analysis revealed two themes; "Participating in the illness journey", which was constructed of the subthemes of facing the unimaginable yet expected, encountering healthcare personnel, and noticing recovery and "Putting oneself aside", which was constructed of the subthemes of placing daily life on hold, giving support, and feeling concern and fear.