No rest for the wounded: early ambulation after hip surgery accelerates recovery.
BACKGROUND
Level 3 evidence-based guidelines recommend first walk after hip fracture surgery within 48 h. Early mobilization is resource and effort intensive and needs rigorous investigation to justify implementation. This study uses a prospective randomized method to investigate the effect of early ambulation (EA) after hip fracture surgery on patient and hospital outcomes.


METHODS
Sixty patients (41 women and 19 men; mean age 79.4 years) admitted between March 2004 through December 2004 to The Alfred Hospital, Melbourne, for surgical management of a hip fracture were studied. Randomization was either EA (first walk postoperative day 1 or 2) or delayed ambulation (DA) (first walk postoperative day 3 or 4). Functional levels on day 7 post-surgery, acute hospital length of stay and destination at discharge were compared.


RESULTS
At 1 week post-surgery, patients in the EA group walked further than those in the DA group (P = 0.03) and required less assistance to transfer (P = 0.009) and negotiate a step (P = 0.23). Patients in the EA group were more likely to be discharged directly home from the acute care than those in the DA group (26.3 compared with 2.4%) and less likely to need high-level care (36.8 compared with 56%). A failed early ambulation subgroup had significantly more postoperative cardiovascular instability and worse results for all outcome measures.


CONCLUSIONS
EA after hip fracture surgery accelerates functional recovery and is associated with more discharges directly home and less to high-level care.
Oldmeadow
Leonie B
LB
Department of Physiotherapy, The Alfred, Melbourne, Australia. l.oldmeadow@alfred.org.au
Edwards
Elton R
ER
Kimmel
Lara A
LA
Kipen
Eva
E
Robertson
Val J
VJ
Bailey
Michael J
MJ
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*