High-intensity versus standard physiotherapy for rehabilitation after hip fracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
92 patients over the age of 65 with a subcapital or intertrochanteric hip fracture were randomized to either high-intensity postoperative physiotherapy (PT) sessions in addition to usual PT, or usual PT alone. The purpose of this study was to compare the length of time to discharge readiness, functional performance measures, and patient-reported function at follow-up between groups. The results demonstrated Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Victorian Department of Health
Conflicts: None disclosed
Why was this study needed now?
Hip fractures are common injuries among the elderly that place a significant burden on the healthcare system and the incidence of these fractures are likely to increase with an aging population. Rehabilitation following these fractures plays an important role in restoring functional ability and reducing the length of hospital stays. However, the ideal rehabilitation protocol has yet to be identified, and while guidelines currently recommend early mobilization and daily physiotherapy following hip fracture fixation, there is limited evidence to inform the decision regarding the intensity of physiotherapy postoperatively.
What was the principal research question?
Are there differences in functional outcome and discharge readiness between high-intensity physiotherapy and usual physiotherapy post-operative rehabilitation for elderly hip fracture patients when assessed in hospital and over a 6-month follow-up period?
Population: 92 patients, 65 years of age or older, with an isolated subcapital or intertrochanteric hip fracture. Cases of subtrochanteric or pathological fracture were excluded. Patients were managed operatively through either internal fixation or hemiarthroplasty.
Intervention: HIP group: Postoperatively, patients underwent a high-intensity physiotherapy program, consisting of two daily sessions of therapy in addition to the standard therapy session provided daily in the morning (as described below). One of the additional sessions was performed under an allied health assistant and focused on progression from morning sessions. The other additional session was performed under a physiotherapist and aimed at functional progress, including independence during gait and distance walked.
Comparison: Usual PT group: Postoperatively, patients underwent a standard physiotherapy program, consisting of one daily session of individually tailored performance of knee and hip strength exercises, and gait training.
Outcomes: The primary outcome was the modified Iowa Level of Assistance measured by a blinded assessor on day 5. Secondary outcomes included the Timed Up and Go (TUG) test of postoperative day (POD) 5, acute hospital stay, inpatient rehabilitation stay, combined hospital length of stay, and time to physical readiness for discharge (determined by a blinded physician). Additionally, discharge destination from acute hospital stay (Home, Fast Stream, or Slow stream rehab), final discharge destination (Home, Low-level care, or High-level care), in-hospital complications, cases of re-admission, and pain medication use within the first 72 hours after surgery were documented. The patient reported outcomes of the Glasgow Outcome Scale, the EuroQoL 5-dimension questionnaire, and the Short Form 12-Item general health survey were also assessed at follow-up.
Methods: RCT; Single-center
Time: The modified Iowa Level of Assistance measure was assessed at POD 5 or at discharge, whichever came first. Patient-reported outcome measures were collected at 6 month follow-up.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.