Physical therapy after femur fracture in elderly patients at the long-term rehabilitation stage

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Femoral neck fractures are the leading cause of disability among the elderly. Rehabilitation is fundamental to restore functionality that was before the fracture. Aim. To conduct an observational cohort study to compare the effectiveness of rehabilitation programs in different therapeutic settings. Materials and methods. Elderly patients who underwent surgical stabilization of femur fracture were included in the study. The participants were divided into 3 groups: group 1 – outpatient rehabilitation; group 2 – inpatient rehabilitation; group 3 – rehabilitation at home. Rehabilitation results were determined at the initial stage, 3 and 6 months after the fracture. The Barthel index, passive and active range of motion in hip flexion and extension, and the muscle strength in flexion, extension, and extension of the knee joint were assessed. Results. In 6 months, all three groups showed statistically significant improvement (p < 0.05) in all indices compared to baseline. Considering the intergroup analysis, the final Barthel index score was significantly higher in patients who were treated as outpatients (88.00 ± 9.6) than inpatients (68.57 ± 11.7), but no statistical difference was found between patients who were treated as outpatients and at home (82.5 ± 10.4). In general, patients who were treated in outpatient settings showed better functional outcomes, while patients who were rehabilitated in inpatient settings had worse outcomes. Patients treated at home showed intermediate final functional outcomes more similar to outpatients. Patients with hip fracture undergoing outpatient rehabilitation were more likely to have better long-term effects of the rehabilitation protocol regarding the functional status, muscle strength in hip flexion, hip extension, and knee extension. Patients referred to home rehabilitation showed intermediate results, closer to outpatients, although they started rehabilitation treatment faster after the hospital discharge. Conclusions. The data obtained indicate that rehabilitation leads to significant functional recovery after femur fracture in elderly patients. Both outpatient and home-based rehabilitation are acceptable rehabilitation options for femoral fractures.