Factors Associated With an Immediate Weight-Bearing and Early Ambulation Program for Older Adults After Hip Fracture Repair

Abstract 

Barone A, Giusti A, Pizzonia M, Razzano M, Oliveri M, Palummeri E, Pioli G. Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair.

Objective

To evaluate baseline characteristics and in-hospital factors associated with nonadherence with an immediate weight-bearing and early ambulation (IWB-EA) program after hip fracture (HF) surgery.

Design

Prospective inception cohort study.

Setting

Ortho-geriatric unit in an acute care hospital.

Participants

Older adults (N=469) admitted with an osteoporotic HF who underwent surgery.

Interventions

Immediate weight-bearing and assisted ambulation training on the first postoperative day (all patients).

Main Outcome Measure

Proportion of subjects who adhered to the IWB-EA protocol within 48 hours of surgery.

Results

A total of 366 patients (78%) bore weight and ambulated within 48 hours (weight-bearing [WB] group) while the others did not adhere to the protocol (nonweight-bearing [NWB] group). Subjects in the NWB group were significantly older, were more cognitively and functionally impaired, and presented a higher comorbidity at baseline. A higher proportion of subjects in the NWB group (42.7%) than the WB group (23.5%; P<.001) underwent surgery on a preholiday day. In multivariate analysis, having surgery on Friday or a preholiday day (the day before a public holiday) remained the most influent variable related to nonadherence to the IWB-EA protocol (odds ratio=2.5; 95% confidence interval=1.6–4.0; P<.001).

Conclusions

This study establishes that IWB-EA is feasible in a high proportion of patients after surgical stabilization of HF. Neither cognitive impairment nor high comorbidity influenced significantly the adherence to the protocol, indicating that IWB-EA may be offered to an unselected population of the elderly with HF. The day of surgery (eg, preholiday or not) was the only variable influencing the participation to the IWB-EA protocol, suggesting the importance of maintaining the same standard of daytime care every day of the week.

Key Words: Hip fractures, Rehabilitation, Weight-bearing

List of Abbreviations: ASA, American Society of Anesthesiologists classification, CI, confidence interval, CIRS, Cumulative Illness Rating Scale, CIx, cumulative index, IWB-EA, immediate weight-bearing and early ambulation, HF, hip fracture, NWB, nonweight-bearing (nonadherence), OR, odds ratio, POD, postoperative day, RCT, randomized controlled trial, SI, severity index, SPMSQ, Short Portable Mental Status Questionnaire, WB, weight-bearing (adherence)