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Prommik P1,2, Kolk H1,2, Märtson A1,2, Pääsuke M1
1University of Tartu, Tartu, Estonia, 2Tartu University Hospital, Tartu, Estonia
Background: Hip fracture (HF) is a challenging healthcare problem due to its low functional recovery and increased mortality. HF is commonly classified as intra- (femoral neck) and extracapsular (pertrochanteric and subtrochanteric) fractures. These fracture types have their differences that affect patient management in rehabilitation. For example, different operative management is used that further leads to diverge postoperative restrictions to limit weight-bearing or avoid dislocations. Despite the differences above, current rehabilitation guidelines manage hip fracture as a single entity and six-month's goal is to restore patient's pre-injury functional status. Physical therapy is an important component of rehabilitation, yet the optimal intensity, frequency and duration of this need to be established for hip fracture. Since intra- and extracapsular fractures are non-identical they may need different utilization of physical therapy to achieve the rehabilitation goal.
Purpose: The purpose of this study was to compare the utilization of physical therapy between patients with an intra- and extracapsular HF.
Methods: A retrospective cohort study was conducted using data from the Estonian Health Insurance Fund's database. Data query included patients aged 50 years or above with an HF diagnosis over a period from January 1, 2017 to June 30, 2017. The follow-up period was 6 months. HF diagnoses were determined using ICD-10 codes and fractures were grouped as following: intracapsular (S72.0 - femoral neck) and extracapsular (S72.1 - pertrochanteric; S72.2 - subtrochanteric) fracture. Data query included patient characteristics and codes used for funding indicating physiotherapy use and duration. Continuous variables are shown as mean and standard deviations (±SD) and categorical variables as proportions. Mann-Whitney U (Wilcoxon rank-sum) test was used to find inconsistencies across the types of fractures.
Results: A total of 667 patients met the inclusion criteria and were included into further analyses. The mean age of patients was 80 (SD 10) years, where 81 (SD 9) is for females and 75 (SD 11) for males. The majority of patients 70% (467/667) were females. Half of the patients, 50.4% (336), had an extracapsular fracture. For all included patients the mean duration of physical therapy used within 6 months after the fracture was 7.4 (SD 9.0) hours that consisted of the following therapies: the mean of 6.8 (SD 8.1) hours for physiotherapy and the mean of 0.62 (SD 2.1) hours for occupational therapy. Fifteen patients attended outpatient physical therapy with a mean duration of 6.6 (SD 5.9) hours. Only 3 patients out of 667 got the home-based physiotherapy with an average of 11.5 (SD 6.6) hours. Patients with intracapsular and extracapsular fracture received the equivalent amount of physical therapy, i.e. 7.2 (SD 8.7), 7.6 (SD 9.4) hours respectively (p = 0.5).
Conclusion(s): Amount of physical therapy used after intra- and extracapsular fractures remains equivalent within six months after HF diagnosis. The utilization of home-based physiotherapy is low in Estonia.
Implications: Rehabilitation plans should manage intra- and extracapsular fractures similarly in terms of physical therapy duration. Study results indicate the need for review the use of home-based physiotherapy in Estonia.
Keywords: hip fracture, rehabilitation, physiotherapy
Funding acknowledgements: The Institutional Research Funding IUT20-58 of the Estonian Ministry of Education and Research.
Purpose: The purpose of this study was to compare the utilization of physical therapy between patients with an intra- and extracapsular HF.
Methods: A retrospective cohort study was conducted using data from the Estonian Health Insurance Fund's database. Data query included patients aged 50 years or above with an HF diagnosis over a period from January 1, 2017 to June 30, 2017. The follow-up period was 6 months. HF diagnoses were determined using ICD-10 codes and fractures were grouped as following: intracapsular (S72.0 - femoral neck) and extracapsular (S72.1 - pertrochanteric; S72.2 - subtrochanteric) fracture. Data query included patient characteristics and codes used for funding indicating physiotherapy use and duration. Continuous variables are shown as mean and standard deviations (±SD) and categorical variables as proportions. Mann-Whitney U (Wilcoxon rank-sum) test was used to find inconsistencies across the types of fractures.
Results: A total of 667 patients met the inclusion criteria and were included into further analyses. The mean age of patients was 80 (SD 10) years, where 81 (SD 9) is for females and 75 (SD 11) for males. The majority of patients 70% (467/667) were females. Half of the patients, 50.4% (336), had an extracapsular fracture. For all included patients the mean duration of physical therapy used within 6 months after the fracture was 7.4 (SD 9.0) hours that consisted of the following therapies: the mean of 6.8 (SD 8.1) hours for physiotherapy and the mean of 0.62 (SD 2.1) hours for occupational therapy. Fifteen patients attended outpatient physical therapy with a mean duration of 6.6 (SD 5.9) hours. Only 3 patients out of 667 got the home-based physiotherapy with an average of 11.5 (SD 6.6) hours. Patients with intracapsular and extracapsular fracture received the equivalent amount of physical therapy, i.e. 7.2 (SD 8.7), 7.6 (SD 9.4) hours respectively (p = 0.5).
Conclusion(s): Amount of physical therapy used after intra- and extracapsular fractures remains equivalent within six months after HF diagnosis. The utilization of home-based physiotherapy is low in Estonia.
Implications: Rehabilitation plans should manage intra- and extracapsular fractures similarly in terms of physical therapy duration. Study results indicate the need for review the use of home-based physiotherapy in Estonia.
Keywords: hip fracture, rehabilitation, physiotherapy
Funding acknowledgements: The Institutional Research Funding IUT20-58 of the Estonian Ministry of Education and Research.
Topic: Orthopaedics; Older people; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: Ethics Committee of the University of Tartu
Ethics committee: Ethics Committee of the University of Tartu
Ethics number: reference 227/T-12
All authors, affiliations and abstracts have been published as submitted.
