Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair.
OBJECTIVE
To evaluate baseline characteristics and in-hospital factors associated with nonadherence with an immediate weight-bearing and early ambulation (IWB-EA) program after hip fracture (HF) surgery.


METHODS
Prospective inception cohort study.


METHODS
Ortho-geriatric unit in an acute care hospital.


METHODS
Older adults (N=469) admitted with an osteoporotic HF who underwent surgery.


METHODS
Immediate weight-bearing and assisted ambulation training on the first postoperative day (all patients).


METHODS
Proportion of subjects who adhered to the IWB-EA protocol within 48 hours of surgery.


RESULTS
A total of 366 patients (78%) bore weight and ambulated within 48 hours (weight-bearing [WB] group) while the others did not adhere to the protocol (nonweight-bearing [NWB] group). Subjects in the NWB group were significantly older, were more cognitively and functionally impaired, and presented a higher comorbidity at baseline. A higher proportion of subjects in the NWB group (42.7%) than the WB group (23.5%; P<.001) underwent surgery on a preholiday day. In multivariate analysis, having surgery on Friday or a preholiday day (the day before a public holiday) remained the most influent variable related to nonadherence to the IWB-EA protocol (odds ratio=2.5; 95% confidence interval=1.6-4.0; P<.001).


CONCLUSIONS
This study establishes that IWB-EA is feasible in a high proportion of patients after surgical stabilization of HF. Neither cognitive impairment nor high comorbidity influenced significantly the adherence to the protocol, indicating that IWB-EA may be offered to an unselected population of the elderly with HF. The day of surgery (eg, preholiday or not) was the only variable influencing the participation to the IWB-EA protocol, suggesting the importance of maintaining the same standard of daytime care every day of the week.
Barone
Antonella
A
Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, Genoa, Italy.
Giusti
Andrea
A
Pizzonia
Monica
M
Razzano
Monica
M
Oliveri
Mauro
M
Palummeri
Ernesto
E
Pioli
Giulio
G
D000368:Aged; D000369:Aged, 80 and over; D004434:Early Ambulation / Q000379:methods*; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D011446:Prospective Studies; D055070:Resistance Training / Q000379:methods*; D013997:Time Factors