Outcomes of Intermediate-Phase Rehabilitation for Fragility Hip Fractures Treated Non-operatively: A Descriptive Study at Kalasin Hospital
DOI:
https://doi.org/10.64960/srimedj.v40i6.269297Keywords:
hip fracture patients, intermediate-phase rehabilitation, non-surgical treatment, fragility fracturesAbstract
Background and Objective: Fragility hip fractures are significant problems in elderly population. This study aimed to evaluate outcomes of intermediate-phase rehabilitation in patients with fragility hip fractures treated non-operatively.
Methods: A prospective descriptive study in 60 patients compared outcomes at baseline, 3 and 6 months. The rehabilitation program consisted of three phases: Phase 1 (weeks 1-4) joint mobilization and isometric exercises 30 minutes, 3 times/week; Phase 2 (weeks 5-12) progressive resistance training and balance exercises 45 minutes, 2-3 times/week; Phase 3 (weeks 13-24) functional activities 60 minutes, 1-2 times/week. Outcomes: Harris hip score (HHS), visual analog scale (VAS), activities of daily living (ADL), and EuroQol-5D (EQ-5D). Data analysis was conducted using statistical software, including descriptive statistics (means, standard deviations, minimum-maximum values) and categorical data analysis (frequencies, percentages), repeated measures analysis of variance, Bonferroni post-hoc test for pairwise comparisons, and Cohen's d for effect size calculation.
Results: Mean scores at 6 months showed significant improvements across all outcome measures: HHS increased from 40.68 to 99.83 points (indicating good functional outcome), VAS decreased from 8.23 to 2.18 points (representing mild pain levels), ADL scores improved from 48.38 to 89.90 points (demonstrating good self-care capabilities), and EQoL enhanced from 0.65 to 0.92 (reflecting complete health status). Repeated measures analysis of variance revealed statistically significant differences across all variables at p < .001.
Conclusion: A structured intermediate-phase rehabilitation program significantly improves functional outcomes, reduces pain, enhances activities of daily living, and improves quality of life in patients with fragility hip fractures treated non-operatively.
References
Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012;23(9):2239-56. doi:10.1007/s00198-012-1964-3.
Pongchaiyakul C, Apinyanurag C, Soontrapa S, Soontrapa S, Pongchaiyakul C, Nguyen TV, et al. Prevalence of osteoporosis in Thai men. J Med Assoc Thai 2006;89(2):160-9.
Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000;55(9):M498-507. doi:10.1093/gerona/55.9.m498.
Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009;170(10):1290-9. doi:10.1093/aje/kwp266.
Parker MJ, Handoll HH, Bhargara A. Conservative versus operative treatment for hip fractures. Cochrane Database Syst Rev 2006;(4):CD000337. doi:10.1002/14651858.CD000337.
National Institute for Health and Care Excellence. Hip fracture: management. Clinical guideline [CG124]. London: NICE; 2011.
American Academy of Orthopaedic Surgeons. Management of hip fractures in older adults. Rosemont, IL: AAOS; 2021.
Handoll HH, Sherrington C, Mak JC. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2011;(3):CD001704. doi:10.1002/14651858.CD001704.pub4.
Diong J, Allen N, Sherrington C. Structured exercise improves mobility after hip fracture: a meta-analysis with meta-regression. Br J Sports Med 2016;50(6):346-55. doi:10.1136/bjsports-2014-094465.
Magaziner J, Chiles N, Orwig D. Recovery after hip fracture: interventions and their timing to address deficits and desired outcomes--evidence from the baltimore hip studies. Nestle Nutr Inst Workshop Ser 2015;83:71-81. doi:10.1159/000382064.
Kristensen MT. Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med 2011;47(2):257-64.
Hulsbæk S, Larsen RF, Troelsen A. Predictors of not regaining basic mobility after hip fracture surgery. Disabil Rehabil 2015;37(19):1739-44. doi:10.3109/09638288.2014.974836.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures : treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-55.
Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res 2001;(384):189-97. doi:10.1097/00003086-200103000-00022.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain. Arthritis Care Res 2011;63 (Suppl 11):S240-52. doi:10.1002/acr.20543.
Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001;8(12):1153-7. doi:10.1111/j.1553-2712.2001.tb01132.x.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J 1965;14:61-5.
Duffy L, Gajree S, Langhorne P, Stott DJ, Quinn TJ. Reliability of the Barthel Index for assessment of stroke survivors: systematic review and meta-analysis. Stroke 2013;44(2):462-8. doi:10.1161/STROKEAHA.112.678615.
EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16(3):199-208. doi:10.1016/0168-8510(90)90421-9.
Tongsiri S, Cairns J. Estimating population-based values for EQ-5D health states in Thailand. Value Health 2011;14(8):1142-5. doi:10.1016/j.jval.2011.06.005.
Kurabe S, Ozawa T, Watanabe T, Aiba T. Efficacy and safety of postoperative early mobilization for chronic subdural hematoma in elderly patients. Acta Neurochir (Wien). 2010;152(7):1171-4. doi:10.1007/s00701-010-0627-4.
Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 2011;22(4):78-83. doi:10.1071/NB10056.
Turk DC, Okifuji A. Psychological factors in chronic pain: evoluation and revolution. J Consult Clin Psychol 2002;70(3):678-90. doi:10.1037/0022-006X.70.3.678.
Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS. Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 2006;166(7):766-71. doi:10.1001/archinte.166.7.766.
Lin PC, Chang SY. Functional recovery among elderly people one year after hip fracture surgery. J Nurs Res 2004;12(1):72-82. doi:10.1097/01.jnr.0000387490.71062.4a.
Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML. Recovery of health-related quality of life in a UK hip fracture population. The Warwick Hip Trauma Evaluation--a prospective cohort study. Bone Joint J 2015;97-B(3):372-82. doi:10.1302/0301-620X.97B3.35738.
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