To describe the implementation of a multidisciplinary rehabilitation approach for older adults with hip fractures in communities of LMIC.
This case series involves retrospective analysis of data from individuals receiving multidisciplinary rehabilitation services from Gurkha Welfare Trust (GWT) in communities of Nepal. Ethical Clearance was obtained from Nepal Health Research Council (NHRC), and written consent obtained prior to documenting the case-series. The study included five female older adults over 65 years of age who had sustained a hip fracture within the past six months, were unable to ambulate, had not received physiotherapy and lived at home. A multidisciplinary team provided community rehabilitation services, consisting of a physiotherapist, a medical doctor, and a health assistant (HA) who completed three years of medical training following primary education.
During the initial visit, the team worked with patient and care-giver to establish individualized rehabilitation goals. After the initial visit, the physiotherapist planned their follow up sessions. Three more complex patients received five sessions, two less complex patients received 3 sessions over a 3 months period. Physiotherapy sessions included active range of motion, progressive lower limb strengthening and gait-training exercises. Care-givers were trained during the sessions and monitored one home exercise session every day for 6 days a week. The HA scheduled a follow-up visit within three months to manage medications and general health conditions, and facilitated teleconsultations with the doctor from the initial visit for the medication-related queries. During visits, the physiotherapist measured hip and knee range of motion (ROM), strength and physical function (Barthel index, modified hip Harris score).
All participants demonstrated improvement in hip flexion, abduction, extension, and knee flexion range of motion (ROM) with mean scores of 88 ± 49, 20 ± 16.20, 16 ± 8.94 and 108 ± 60.37 degrees respectively at three months. Additionally, all participants showed improvement in hip and knee muscle strength. The Barthel index increased from a mean of 30 ± 6.12 to 87 ± 2.73 points. The modified Hip Harris score improved from a mean 25 ± 8.27 to 59.4 ± 3.43 points. By the end of the rehabilitation period, three patients could ambulate independently with a walking frame and two patients used a tripod stick for ambulation.
This case series suggests multidisciplinary community rehabilitation that includes physiotherapy in a LMIC such as Nepal for older adults following hip fracture is possible and can be effective, despite limitations such as low awareness and limited resources. Further research is needed with more participants and in varied LMIC settings.
In LMIC with limited manpower and resources, a multidisciplinary community rehabilitation approach can be a viable alternative for older adults with hip fractures.
Hip fractures
Low and middle income countries
