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.
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.
Prospective inception cohort study.
Ortho-geriatric unit in an acute care hospital.
Older adults (N=469) admitted with an osteoporotic HF who underwent surgery.
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.
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).
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.
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))
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