Ann Rehabil Med.  2021 Jun;45(3):225-259. 10.5535/arm.21110.

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures

• Min K
• Beom J
• Kim BR
• Lee SY
• Lee GJ
• Lee JH
• Lee SY
• Won SJ
• Ahn S
• Bang HJ
• Cha Y
• Chang MC
• Choi JY
• Do JG
• Do KH
• Han JY
• Jang IY
• Jin Y
• Kim DH
• Kim DH
• Kim IJ
• Kim MC
• Kim W
• Lee YJ
• Lee IS
• Lee IS
• Lee J
• Lee CH
• Lim SH
• Park D
• Park JH
• Park M
• Park Y
• Ryu JS
• Song YJ
• Yang S
• Yang HS
• Yoo JS
• Yoo Ji
• Yoo SD
• Choi KH
• Lim JY

• KMID: 2517601
• DOI: http://doi.org/10.5535/arm.21110

Abstract

Objective
The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost.
Conclusion
This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Keyword

Hip fractures; Practice Guideline; Rehabilitation; Patient Care Team; Community Health Services

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