C. Astolphi Lima1, C. Sherrington2, N. Cirino1, M. Perracini1,3
1University City of Sao Paulo, Master’s and Doctoral Programs in Physical Therapy, São Paulo, Brazil, 2University of Sydney, School of Public Health, Sydney, Australia, 3Faculty of Medical Sciences, Universidade Estadual de Campinas, Master’s and Doctoral Programs in Gerontology, Campinas, Brazil
Background: Insufficient recovery of mobility increases the risk of future falls and fractures in older adults following hip fracture surgery. Rating the risk of falling and discover how rehabilitation programs have been delivered to older adults after hip fracture may help to be optimized recovery in this population.
Purpose: To investigate the risk of falling and the characteristics of rehabilitation in the older people after the acute phase of hip fracture surgery.
Methods: Cross-sectional study conducted with secondary data from a clinical trial (REATIVE Study). Were included older adults (³ 60 years old), men and women, post hip fracture surgery. A structured multidimensional questionnaire was used to evaluate health status, fractured characteristics and rehabilitation. Physiological risk of falling was measured using the long version of the Profile Physiological Assessment that evaluates different systems involved in the postural control. Descriptive statistics were used for sample characterization.
Results: 70 older adults (85.7% female) with mean age 77.9±7.9 years old were included. Mean fracture time was 15.5±9.9 months. Mostly, participants were above 6 months after the hip fracture surgery (97%). High or very high risk of falls was observed in 73% of participants. Approximately 90% of participants were referred to rehabilitation, but most of them did less than a month or up to 3 months. More than a half (65.8%) remained using walking devices. Frequency of rehabilitation was once or twice a week for 90% of participants. Exercises components mostly included in rehabilitation intervention were resistance training with load (68.4%), gait training (73.7%), balance training (57.9%) and transfers (54.4%).
Conclusion(s): Older people after hip fracture surgery have a high physiological risk of falling, even several months after the surgery. The short time involved in rehabilitation could be contributed to an insufficient recovery and lead to the high risk of falling observed. Among fall prevention interventions balance exercises are critically important. However, in our study only nearly half of participants performed balance-training exercises. Proper structured exercises and tailored multifactorial interventions to decrease the physiological risk of falling must be included in the pathway of care of these patients.
Implications: The implications of the present study are not only related to clinical practice but, also for structuring long-term care services, particularly rehabilitation, for older people after hip fracture surgery. Although rehabilitation after hip fracture encompasses a wide variety of interventions across time points after surgery, it’s important to reinforce that patients must be treated using the best evidence available. The recommendation is to deliver progressive resistance and balance training that should and be extended beyond early rehabilitation (from hospital discharge until 6 months). Balance training should cover all-important dimensions Not only functional recovery is crucial but also to decrease the risk of falling.
Funding, acknowledgements: FAPESP
Keywords: hip fracture, balance recovery, older adults
Topic: Older people
Did this work require ethics approval? Yes
Institution: University City of São Paulo
Committee: UNICID
Ethics number: CAAE 27398814.7.0000.0064
All authors, affiliations and abstracts have been published as submitted.
