Viewpoint: time to change hip fracture rehabilitation

The CSP has worked with the British Orthopaedic Association (BOA) in an evaluation of orthopaedic rehab services.

We were shocked by the current outcomes for people following a hip fracture. It appears that:  
  • about half do not regain their previous level of mobility and independence
  • just half of those admitted from home go back there within 30 days
  • one third of people with no history of depression have significant depressive symptoms six weeks after their fracture

Some hip fracture rehab services 

In England have high-quality pathways but there are unacceptable variations in practice and too few seven-day and integrated services. 
The National Institute for Health and Care Excellence hip fracture guidance recommends physiotherapy assessment and mobilisation within 24 hours post-operatively. The Scottish intercollegiate guidelines network recommends starting multidisciplinary rehab within the same time frame. Seven-day physio services are needed to comply with this and the guidance provides a useful lever for those trying to increase their service provision.   
Rehabilitation delivered immediately and intensively after hip fracture surgery helps people to regain their independence and lead full and active lives. Yet there is a general perception that patients are ‘mobilised’ post-operatively and rehab is only offered once the patient is discharged from the acute sector.  
Rehabilitation that includes strengthening, endurance and falls prevention can help people achieve a higher functional level and quality of life than before their fracture. However, the report suggests that many patients receive inadequate rehab far too late.  
Supporting these patients currently costs £2 billion a year. Rehab is cost effective and frees up resources. Data on physiotherapy mobilisation within 24 hours has been included in the National Hip Fracture Database since April 2014 and its managers are keen to continue working with the CSP on adding more rehab relevant metrics.
All services have a responsibility to demonstrate the quality of their rehabilitation in the acute and community sectors. We need to show that physiotherapy can help these patients regain their independence, return to their homes and prevent avoidable mental health problems.  
The CSP is to commission a Physiotherapy works project to develop best practice guidance for hip fracture rehab in all settings. The project will also evaluate the economic evidence and develop resources and tools to support the planning and delivery of high-quality rehabilitation services.
Services with data to support their hip fracture rehabilitation service can email me at 
  • Gabrielle Rankin is a CSP research adviser

More information

  • Find the BOA report here, and search for girft’
Gabrielle Rankin CSP research adviser

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