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Abstract
Background and Aims: Patients with hip fracture undergoing osteosynthesis often post-operatively receive the recommendation by a surgeon to stand with only half their weight or not to stand at all on the operated leg for six weeks. Knowing very little about the consequences of this restriction, we investigated the impact of weight-bearing restriction on rehabilitation outcome among such patients, particularly those with concomitant dementia.
Material and Methods: We investigated all patients with hip fracture (N = 98, mean age 80.2) in Lahti City hospital from Jan 1, 1998 to Dec 31, 1999, and as a specific subgroup, demented patients (N = 36) with Mini Mental State Examination score of ≤ 24/30. The patients' outcome data came from their medical records. The main outcome measure was the length of active rehabilitation including physical therapy after surgery.
Results and Conclusions: In this study the most common surgical method to treat hip fracture was osteosynthesis (55%). Most patients having osteosynthesis were recommended by a surgeon to have a weight-bearing restriction (61%). Among all patients the active rehabilitation took 53.1 days for those who attempted the recommended mobility restriction (N = 37) and 38.4 days for those who had not such limitations (N = 61) (p = 0.03). Whereas 84% of patients whose surgery required no restrictions learned to walk independently with or without aids inside the rehabilitation ward within 6 weeks, the comparable figure was only 41% in the group with restrictions (P < 0.001). Among demented patients (MMSE range 1-24, median 18) the rehabilitation time for those who had restriction (N = 12) compared to those who did not (N = 24) was significantly longer (73.5 days vs 45.5 days) (P = 0.03). Even though 81% of our demented patients were living at home while having the fracture, only half (56%) of them could be discharged to home after the rehabilitation and the rest (44%) needed permanent hospitalization. Whereas 20 of 24 were able to walk in the non-restricted group, in the restricted group only 1 of 12 could.
Thus, a strict weight-bearing restriction may impair rehabilitation outcome among all patients with hip fracture and may be particularly harmful to patients with dementia who cannot observe such limitations. This finding may have implications for surgical and rehabilitation methodology.
Additional information
Notes on contributors
Olli Korkala
Jennifer R. Johnson was a graduate student in the School of Occupational Therapy, Texas Woman's University, Houston, TX at the time of this study. She is currently employed as an Occupational Therapist at Touro Infirmary in New Orleans, LA
Debra Stewart is Lecturer, School of Rehabilitation Science, McMaster University and staff therapist at Erinoak Centre, Missis-sauga, Ontario. She is currently completing a MSc (Design, Measurement and Evaluation) at McMaster University.
Ronald L. Mace (deceased, June 29, 1998) was also affiliated with The Center for Universal Design, School of Design, North Carolina University.
Lois Rosage and Geraldine Shaw are Occupational Therapist Consultants who provide evaluations for the housing programs at the Philadelphia Corporation for Aging.
Lois Rosage and Geraldine Shaw are Occupational Therapist Consultants who provide evaluations for the housing programs at the Philadelphia Corporation for Aging.
Debbie Rand is Occupational Therapist, Beit Rivka Geriatric Rehabilitation Hospital, Petach Tikva, Israel. She completed this study in partial fulfillment of the requirements for the Master of Science degree in Occupational Therapy, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem. Her mailing address is 50 Heh B'Eyar Street, Apartment 5, Rosh Ha'Ayin, Israel, 48056.
Maureen McKenna is a Licensed Physical Therapist and Licensed Marriage and Family Therapist in California. Her Current position is: Assistant Professor of Physical Therapy, Wheeling Jesuit University, 316 Washington Avenue, Wheeling, WV 26003.
Heather Lambert was funded in part by a Health Canada NHRDP Fellowship, a REPAR Fellowship, a doctoral bursary from the Fonds de la Recherche en Santé du Quebec, and a Canadian Occupational Therapy Foundation-Royal Canadian Legion Fellowship in Gerontology.
Trish Wielandt was supported by a University of Queensland Postgraduate Research Scholarship (UQPRS).
Dr. Leigh Tooth was supported by a NHMRC Fellowship (#997032) while some of this research was undertaken.
J. D. “Herb” Herbert is Occupational Therapist, Rocky Mountain Menders LLC, 363 Pioneer Road, Lyons, CO 80540. At the time of this study, he was a graduate student, Department of Occupational Therapy, Colorado State University, Fort Collins, CO.