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
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))To read this article in full you will need to make a payment
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Article info
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
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Copyright
© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
