Hip fracture is a global health problem [1]. It is very common among older people and associated with 18 to 33% increased one-year mortality, as well as poor, incomplete long-term recovery [1]. Despite the pressing nature of this issue, research over the last three decades has not offered novel insights into the recovery process [1]. However, studies have identified areas of emphasis within recovery regimes. This article will explore some of them to help medical professionals design the best possible recovery protocol for hip fracture patients.
A cornerstone of hip fracture recovery is exercise [2]. In particular, physical therapy (PT) is common among American hip fracture patients, with 90% being discharged from the hospital to post-acute care (PAC) [3]. PT often takes the form of resistance and functional training [4]. It is associated with improved strength, functional motor performance, and balance [4]. The success of a PT regime hinges on more than just the nature of the physical activities performed. Other elements, such as trust, education about the benefits of the process, gradual progress, and interdisciplinary collaboration are also important to ensure that patients benefit as much as possible from PT [3].
Patients can also benefit from non-PT exercise regimes. For instance, Latham and colleagues studied the efficacy of a home exercise program that was administered with minimal contact between the patient and a physical therapist [5]. The intervention group executed functionally-oriented exercises in their homes for six months, while the control group received cardiovascular nutrition education [5]. Although the researchers did not note significant differences between the groups in terms of mobility, the intervention group scored notably better on the SPPB and AM-PAC measures of daily activity and, generally, experienced modest improvements in physical function by the end of the trial [5]. The clinical significance of these results is unclear, but they point to the potential benefits of non-PT exercise regimes, even if those benefits do not seem as unequivocal, wide-ranging, or pronounced as those associated with PT.
Hip fracture patients can also benefit from psychotherapy or emotional coaching. This type of injury can produce or exacerbate depression and anxiety; as a result, receiving adequate psychological care is crucial to recovery [6]. Some patients have noted how speaking with a therapist has boosted their confidence and provided them with emotional support [7]. Indeed, research finds that counseling results in a higher quality of life and lower pain scores among patients [6]. Rather than be overlooked, the mental dimensions of the healing process should be taken just as seriously as the physical elements to ensure that patients can recover as much of their pre-injury health as possible.
One last important element of hip fracture recovery is pharmacology [4]. Hip fractures often result from bone fragility, which can be caused by osteoporosis [4]. Two types of medications can be used to treat osteoporosis: anabolic and antiresorptive treatments [4]. Zoledronic acid, an FDA-approved antiresorptive medication, is associated with reduced mortality [4]. It does not appear, however, to speed along the recovery process, but rather prevents patients from backtracking by lowering the probability of future injury [4].
In conclusion, while hip fracture is often experienced by patients as a life-altering event, these various interventions, especially when administered in combination, can improve patients’ chances of recovery from hip fracture [1, 4].
References
[1] V. Bruun-Olsen, A. Bergland, and K. E. Heiberg, “‘I struggle to count my blessings’: recovery after hip fracture from the patients’ perspective,” BMC Geriatrics, vol. 18, no. 18, pp. 1-9, January 2018. [Online]. Available: https://doi.org/10.1186/s12877-018-0716-4.
[2] D. Langford et al., “‘Life Goes On.’ Everyday Tasks, Coping Self-Efficacy, and Independence: Exploring Older Adults’ Recovery from Hip Fracture,” Qualitative Health Research, vol. 28, no. 8, pp. 1255-1266, July 2018. [Online]. Available: https://doi.org/10.1177/1049732318755675.
[3] N. E. Leland et al., “Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners,” Disability and Rehabilitation, vol. 40, no. 6, pp. 646-654, 2018. [Online]. Available: https://doi.org/10.1080/09638288.2016.1273973.
[4] L. A. Beaupre et al., “Maximising functional recovery following hip fracture in frail seniors,” Best Practice & Research Clinical Rheumatology, vol. 27, no. 6, pp. 771-788, December 2013. [Online]. Available: https://doi.org/10.1016/j.berh.2014.01.001.
[5] N. K. Latham et al., “Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture,” JAMA, vol. 311, no. 7, pp. 700-708, February 2019. [Online]. Available: https://doi.org/10.1001/jama.2014.469.
[6] M. Gambatesa et al., “Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture,” Journal of Multidisciplinary Healthcare, vol. 6, pp. 335-346, September 2013. [Online]. Available: https://doi.org/10.2147/JMDH.S48240.
[7] M. Pol et al., “Everyday life after a hip fracture: what community-living older adults perceive as most beneficial for their recovery,” Age & Ageing, vol. 48, no. 3, pp. 440-447, May 2019. [Online]. Available: https://doi.org/10.1093/ageing/afz012.