![]() ![]() Many centres have moved away from the mandatory check X-ray before mobilisation was allowed. Concerns regarding early mobilisation leading to failure of surgical fixation have been addressed with improved surgical techniques and implants. These included hypotension, inadequate pain control and delirium, which are potentially modifiable with robust preoperative care and planning by the multidisciplinary team. Barriers to early mobilisation were reported in a UK hip fracture physiotherapy audit. However, there are challenges to doing it. There is convincing evidence of the harm from prolonged immobility, and literature to support early mobilisation benefits, even if it were just to stand out of bed. Would different levels of early mobilisation intensity and subsequent progression of the patient’s mobility make a difference?Įven with this uncertainty, getting older people out of bed as soon as possible after hip surgery makes intuitive sense. ![]() Perhaps units that promote early mobilisation have an embedded culture that facilitates rehabilitation and recovery, and this ultimately delivered the benefit reported in this particular study. The NHFD records mobilisation as being able to sit or stand out of bed. However, defining ‘early mobilisation’ and what it entails to maximise its benefit needs further exploration. Additionally, those mobilised earlier had better walking distance and ability to transfer. The patient benefit seen here mirrored what was reported in the only randomised controlled trial to date of 60 patients where those mobilised within 48 hours after surgery were more likely to be discharged home from hospital. , a target of 36 hours post-operatively was set as the threshold for early mobilisation. This points towards an international consensus of how soon after surgery early mobilisation should take place. The target of mobilising on either the day of, or the day following surgery, has been set in a number of national hip fracture registries as the standard to aim for. Īlthough the risk of post-operative complications, disability and mortality increases with longer time to ambulation, setting a time threshold allows clinical teams to work towards a target that is specific and measurable. Four out of five patients were either discharged to home or to another rehabilitation unit, rather than to a care home. In those mobilised early, there were additional discharges seen every day, reaching a peak at 2 weeks after their operation. It showed that early mobilisation within 36 hours after surgery was associated with an almost 2-fold increase in the rate of hospital discharge at 30 days post-operatively. This is the largest study to date looking at the association between early mobilisation and any health outcome. utilised data from the UK National Hip Fracture Database (NHFD) involving over 135,000 patients admitted to hospitals in England and Wales over a 3-year period to study the impact of early mobilisation on hospital discharges. A longer period of immobility has been shown to be associated with an increased risk of pneumonia, delirium, disability and lower survival post-fracture. However, early surgery that is not accompanied by promptly getting the older person out of bed to start their rehabilitation remains only part of an effective intervention. This goal is consonant with the evidence-based recommendation for early surgical fixation soon after hospital admission. The goal of hip fracture treatment is to get the older person back on their feet as soon as possible. Hip fracture, early mobilisation, rehabilitation, older person Key pointsĮarly mobilisation must follow on from early hip fracture surgery as delayed ambulation leads to poor post-operative outcomes.Įarly mobilisation post-operatively was associated with better mobility and more discharges from hospital.Įmbedding it into routine clinical practice will require involvement of the orthogeriatric multidisciplinary team. ![]()
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