Associations between post-operative rehabilitation of hip fracture and outcomes: national database analysis

Bowen Su,Michael Soljak,Harry Soljak,Roger Newson

doi:10.1186/s12891-018-2093-8

Abstract

BackgroundRehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation interventions with post-operative hip fracture outcomes.MethodsCross-sectional (2013–2015) analysis of data from the English National Hip Fracture Database (NHFD) from all 191 English hospitals treating hip fractures. Of 62,844 NHFD patients, we included 17,708 patients with rehabilitation treatment and 30-day mobility data, and 34,142 patients with rehabilitation treatment and discharge destination data. The intervention was early mobilisation rehabilitation treatments delivered by a physiotherapist (PT, physical therapist in North America) or other clinical staff as identifiable in NHFD. We used ordinal logistic and propensity scoring regression models to adjust for confounding variables including age, sex, pre-fracture mobility, operative delay, and cognitive function and peri-operative risk scores.ResultsIn both the adjusted multivariate and propensity-weighted analyses, mobilisation on the day or the day following surgery is associated with better mobility function 30 days after discharge. However patients mobilised by a PT did not have better mobility compared to mobilisation by other professionals. Patients who received a PT assessment were not protected from poorer mobility 30 days after discharge, compared with those who did not receive an assessment. The discharge destination outcome is also better in mobilised than unmobilised patients, whether done by a PT or another health professional, and the difference persists, slightly attenuated, after propensity weighting.ConclusionsIn addition to the type of health professional initiating mobilisation, data on rehabilitation treatment activity and post-operative gait speed is needed to determine optimum rehabilitation dosage and functional outcome. After adjustment patients mobilised by non-PTs did as well as patients mobilised by PTs, suggesting that PTs’ current roles in very early rehabilitation should be reconsidered, with a view to redeploying them to more specialised later rehabilitation activity.

Highlights

Rehabilitation programmes are used to improve hip fracture outcomes
Summary In summary, we investigated the associations of early mobilisation, as a proxy for rehabilitation, mainly delivered by PTs, with two outcome variables, both before and after adjustment for confounding variables
We found that early mobilisation is associated with better mobility function

Summary

Introduction

Rehabilitation programmes are used to improve hip fracture outcomes. There is little published trial clinical trial or population-based data on the effects of the type or provider of rehabilitation treatments on hip fracture outcomes. We evaluated the associations of rehabilitation interventions with post-operative hip fracture outcomes. Hip fractures in later life result in a high morbidity and mortality rate, with an often permanent decline in mobility, independence and quality of life [1]. Over a third of patients will have died 1 year after the fracture, compared with an expected annual mortality of about 10% in this age group [2]. People suffering a hip fracture frequently have other medical and physical problems, including impaired physical and cognitive function [6, 7]. There is a significant psychological effect of hip fracture [8]

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