title: Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair.
abstract: 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.
authors.affiliation: Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, Genoa, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Barone
authors.forename: Andrea
authors.initials: A
authors.lastname: Giusti
authors.forename: Monica
authors.initials: M
authors.lastname: Pizzonia
authors.forename: Monica
authors.initials: M
authors.lastname: Razzano
authors.forename: Mauro
authors.initials: M
authors.lastname: Oliveri
authors.forename: Ernesto
authors.initials: E
authors.lastname: Palummeri
authors.forename: Giulio
authors.initials: G
authors.lastname: Pioli
mesh_terms: 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