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.
Bibliographical noteFunding Information:
This guideline was developed with financial support from the Korean Academy of Rehabilitation Medicine (KARM) and the Korean Academy of Geriatric Rehabilitation Medicine (KAGRM). However, the development was not affected by the supporting academies and was not supported by other groups. All members involved in the development of the guideline (43 members of a development committee) had no conflicts of interest (COI) related to this study. The COI was required to indicate whether or not to be involved in the development of similar guidelines, employment, financial interests, and other potential interests.
The development of the guideline was supported by the Korean Academy of Rehabilitation Medicine and Korean Academy of Geriatric Rehabilitation Medicine. We would like to express our sincere gratitude to external reviewers and advisors for CPG methodology: Woong Ju, MD, PhD (Department of Obstetrics and Gynecology, Ewha Womans University, Korea); Yong-Chan Ha, MD, PhD (Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Korea); Chul Kim, MD, PhD (Department of Rehabilitation Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Korea); Soo Young Kim, MD, PhD (Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Korea); Doyeun Oh, MD, PhD (Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Korea); Kyoung Ha Park (ONES Global); Si-Bog Park, MD, PhD (Department of Rehabilitation Medicine, Hanyang University College of Medicine, Korea); and Jong Lull Yoon, MD, PhD (Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Korea).
© 2021. by Korean Academy of Rehabilitation Medicine.
- Community Health Services
- Hip fractures
- Patient Care Team
- Practice Guideline