Physiotherapy, The University of Melbourne, Melbourne, Australia.
Physiotherapy, Western Health, St Albans, Australia.
J Geriatr Phys Ther. 2021;44(2):88-93. doi: 10.1519/JPT.0000000000000284.
Hip fracture guidelines emphasize mobilization within 48 hours of surgery. The aims of this audit were to determine the proportion of patients with hip fracture who mobilize within 48 hours, identify factors associated with delayed mobilization, and identify barriers to mobilization.
Single-site prospective audit of 100 consecutive patients (age 82 ± 9 years) admitted for surgical management of hip fracture. Data collected included time to mobilization, factors that may impact mobilization (age, weight-bearing status, additional injuries, premorbid mobility status, time to surgery, dementia, delirium, and postoperative complications), and barriers to mobilization as identified by the physical therapist.
Mobilization within 48 hours of surgery was achieved by 43% of patients. Multivariate logistic regression demonstrated odds of mobilizing early increased with higher New Mobility Scores, representing better premorbid mobility (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.06-1.60); odds reduced if delirium was present on day 1 or 2 (OR = 0.25; 95% CI, 0.08-0.79). New Mobility Scores 5 or more, which indicate independent premorbid mobility inside and outside the house, best predicted early mobilization in patients who did not develop delirium. No cutoff score was identified for those with delirium. Identified barriers to mobilization included patient confusion, manual handling risk, patient declined, and hypotension.
Less than half of this cohort achieved the guideline of mobilization within 48 hours of surgery. Patients who develop delirium within the first 2 days of surgery or who had premorbid mobility limitation were less likely to mobilize. Identification of patients likely to have delayed mobilization will assist physical therapists with delivering appropriate management to patients with hip fracture during their acute hospital stay.
髋部骨折指南强调在手术后 48 小时内进行活动。本次审核的目的是确定在 48 小时内活动的髋部骨折患者比例，确定与延迟活动相关的因素，并确定活动障碍的原因。
对 100 例连续接受手术治疗的髋部骨折患者（年龄 82 ± 9 岁）进行单站点前瞻性审核。收集的数据包括活动时间、可能影响活动的因素（年龄、承重状态、其他损伤、术前活动能力、手术时间、痴呆、谵妄和术后并发症）以及物理治疗师确定的活动障碍原因。
43%的患者在手术后 48 小时内活动。多变量逻辑回归表明，较高的新活动能力评分（代表更好的术前活动能力）增加了早期活动的几率（优势比[OR] = 1.30；95%置信区间[CI]，1.06-1.60）；如果第 1 天或第 2 天出现谵妄，则几率降低（OR = 0.25；95%CI，0.08-0.79）。新活动能力评分为 5 分或以上，表明患者术前可独立在室内外活动，在未出现谵妄的患者中，最佳预测了早期活动。对于出现谵妄的患者，没有确定最佳的活动能力评分。确定的活动障碍包括患者困惑、人工搬运风险、患者拒绝和低血压。
该队列中不到一半的患者在手术后 48 小时内达到了活动指南的要求。在手术后的前 2 天内出现谵妄或术前活动能力受限的患者不太可能活动。识别可能延迟活动的患者将有助于物理治疗师在患者急性住院期间为髋部骨折患者提供适当的管理。
