Hip Fracture - Quality Statement 13: Rehabilitation

Resources Quality Statements Advisory Committee About

Rehabilitation

Patients with hip fracture participate in an interdisciplinary rehabilitation program (in an inpatient setting, a community setting, or a combination of both) with the goal of returning to their pre-fracture functional status.

Background

On discharge from the acute care hospital, all hip fracture patients—including patients with cognitive impairment and those residing in long-term care homes—should have the opportunity to participate in an active interdisciplinary rehabilitation program. Rehabilitation programs have been shown to improve patient outcomes, including but not limited to functional status, leg strength, health status, balance, mobility, instrumental activities of daily living, and social functioning.

What This Quality Statement Means

For Patients

When you leave the hospital, you should be offered a rehabilitation program to help get you back to the activities you were able to do before your fracture.

For Clinicians

Provide a rehabilitation program to your hip fracture patients that includes therapies to improve independence in self-care, balance and gait assessment and training, nutritional supplementation, education on safety and fall prevention, a restorative and/or maintenance exercise program, environmental modifications, osteoporosis management and education, and medication management.

For Health Services

Ensure that systems, processes, and resources are in place to allow all hip fracture patients, regardless of cognitive impairment or setting, to participate in a rehabilitation program following surgery.

Quality Indicators

Process Indicators

Percentage of hip fracture patients who participate in a postoperative interdisciplinary rehabilitation program

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture who undergo surgery for hip fracture
Numerator: number of people in the denominator who participate in a postoperative interdisciplinary rehabilitation program
Data source: Continuing Care Reporting System, Discharge Abstract Database, Home Care Database, National Rehabilitation Reporting System, local data collection

Median number of days after surgery that hip fracture patients begin a rehabilitation program

Data source: Continuing Care Reporting System, Discharge Abstract Database, Home Care Database, National Rehabilitation Reporting System, local data collection

Definitions Used Within This Quality Statement

Rehabilitation program

An effective hip fracture rehabilitation program includes the following:

Therapies to improve independence in self-care
Balance, strengthening, and gait assessment and training
Nutritional supplementation
Education on safety and fall prevention
Environmental modifications
Osteoporosis management and education
Medication management
Pain management education
Positioning education for comfort and pressure relief
Transfer training
Stair training
An ongoing exercise program following completion of formal rehabilitation

Evidence to Improve Care