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Hip Fracture Rehabilitation
Hip fractures are a debilitating injury that is primarily seen in elderly people. Rehabilitation has been proven to increase daily functional status (activities of daily living).

Supervised outpatient vs. home exercises during hip rehabilitation
Supervision of hip fracture rehabilitation is essential for the health and successful of recovery. One study investigated supervised outpatient rehabilitation of progressive resistance (strength training) training to improve functional status compared to low intensity home exercises after a hip fracture. Home exercises were meant to replicate care given at a rehabilitation center following hip fracture. Exercises were performed three times a week and focused on flexibility. Exercises performed by the supervised group in phase 1 included balance, movement speed, flexibility, ambulation, and muscle strength. When safe to advance, patients exercised five minutes on a treadmill or stationary bike and progressively increased to fifteen minutes. Phase 1 was designed to help patients prepare for progressive resistance training and reduce any chance of secondary injuries. See figure 1.

Phase 2 included progressive resistance training of 1RM that was measured on knee extension and flexion, leg press, seated bench press, and biceps curl. Hip rehabilitation strengthens the main areas prone to break after a fall: spine, hips, and the forearm. Specifically, strengthening the biceps will increase bone density as well as providing upper extremity strength to perform progressive resistance training for hip rehabilitation. Initially, subjects would perform 1-2 sets of 6-8 repetitions at 65% of 1RM. After a month of weight training, it was increased to 3-8 sets of 6-8 repetitions at 85% - 100% of 1RM. See Figure 2. Phase 1 and 2 sessions lasted 45-90 minutes, three times a week, and thirty-six sessions must be completed before progression to the next stage.



After six months of examining supervised outpatient physical therapy and unsupervised home exercises, the supervised group had improved strength, balance, perceived quality of life and walking speed as well as reduced disability.

Intervention group: geriatric ward for hip rehabilitation
Another study examined 243 patients over age 65 with hip fractures and divided them into two groups: the control group (standard hospital care) and the intervention group (geriatric ward for rehabilitation; geriatric care management). The intervention group received two weeks of intense rehabilitation to assist with early ambulation, hip functioning, and self-motivation. The intervention group recovered daily living activities faster than the control group.

Functional outcome of hip fracture rehabilitation
Being a primary reason for dependency, disability, and death in elderly adults, a study examined the outcome of hip fractures after rehabilitation. By examining 2177 patients, outcome measures (mortality, poor outcome, return home, length of hospital stay, and functional level) were recorded. Patients who received rehabilitation were less likely to have a “poor outcome” and a higher probability of returning home supporting rehabilitation to increase mobility success after surgery.

Exercise prescription specific to patient
An additional study supports rehabilitation of hip fractures but cautions that the exercise prescription needs to be specific to the patient. It is important to understand and anticipate issues that could possibly arise when performing evidence- based care such as weakness, arthritis or decreased range of motion. There needs to be appropriate transitions between stages of care and possibly treatment of osteoporosis.

Incorporation of analgesic regimen
Postoperative pain of a hip fracture can inhibit rehabilitation but incorporation of an analgesic regimen can improve it. A study investigated the schedules of analgesic dosing between 400 patients with hip fractures and separated them in to two groups: the control group (analgesic administration upon request) and the intervention group (analgesic administration for the initial three weeks following surgery). The intervention group had improved functional outcomes and had a higher functional ability on discharge. However, there was no difference in rest and dynamic pain between the two groups in terms of postoperative pain.