Effectiveness of preoperative Physical Therapy for elderly patients with a hip fracture
A hip fracture is the most common fracture older adults and cases of hip fracture grow in economically developed countries worldwide due to aging. The current retrospective observational study aims to clarify the effectiveness of preoperative physiotherapy for elderly patients after a hip fracture in a hospital for acute care.
Pre-operative physical therapy consists, in addition to active ankle movements aimed at the prevention of deep venous thrombosis, movement exercises, sitting exercises, muscle strengthening and exercises aimed at the lower limbs and torso. Exercises were provided by physiotherapists without weight load on the affected side. A pre-operative rehabilitation program consists of 20-30 minutes of bed physiotherapy every weekday. The indication of preoperative rehabilitation in patients with an acute hip fracture was decided on the discrepancy of the treating physician and the policy of the participating institution.
For the current retrospective observational study, data from the Japan Rehabilitation Database were analyzed for patients who were admitted to an acute hospital with a hip fracture between 2005 and 2015. In this study, all eligible patients were operated within 10 days of admission. Propensity score analysis was used to compare outcomes between patients undergoing pre-operative rehabilitation and those who did not. The primary result can be described as motor Functional Independence Measure (FIM) profit.
Of the 681 patients who were eligible after applying exclusion criteria, 50% underwent pre-operative rehabilitation after a hip fracture. The FIM increase in motor was significantly higher, both before and after adjustment by inverse probability, in patients undergoing pre-operative rehabilitation (motor FIM gain 31.1 ± 18.2 before weighing, 31.1 ± 18, 2 after weighing) than those who did not undergo this operation (engine FIM gain 24.6 ± 18.1 for weighing, P <0.01; 26.2 ± 17.6 after weighing, P <0.02). The motor FIM effectiveness and motor FIM were also significantly higher in patients who underwent pre-operative rehabilitation.
The data suggest that pre-operative rehabilitation after a hip fracture may be associated with better rehabilitation results than no pre-operative rehabilitation. Broader use of pre-operative rehabilitation is promising for improving the quality of rehabilitation management.