Post-stroke hip fracture in older people: A narrative review

Abstract

Background/Aims: A hip fracture is a serious and common complication after stroke. Individuals often experience particular gait problems post-stroke and may have difficulty with everyday activities such as walking. Therefore, the interventions for falls prevention in older patients should be re-examined when applied to the post-stroke population. This study reviews the risk factors for falls and hip fractures that are specific to the post-stroke population and the measures that may be taken to prevent hip fractures and/or falls in this patient group. Method: A narrative review of articles written in English in the scientific literature on the risk factors, natural history and prevention of hip fractures in post-stroke patients. Results: The interventions that were reviewed showed some benefit to post-stroke patients. These included interventions designed to increase physical activity, water-based exercise, general falls prevention programmes, and the use of force platforms and body weight supported treadmills. More solid evidence was found to support strategies such as the symmetrical use of limbs, which provides appropriate support and an environment where an individual can regain more normal movement patterns. This can be achieved by training in a low-gravity environment using water-based exercises or a body-weight supported treadmill. To perform more symmetrical movements, biofeedback (visual feedback) or a force platform can be used in addition to symmetrical exercises. Conclusions: In a post-stroke population, it is better to pay special attention to the prevention of falls and hip fracture than to rehabilitate after a fracture has occurred. Evaluation and management of the risk factors that contribute to falls should be a priority in post-stroke rehabilitation, focusing on as many risk factors as possible in hip fracture prevention programmes. A variety of techniques should be used to facilitate functional recovery, emphasising symmetry and optimal movement patterns.