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Recovering after a hip fracture: helping people understand physiotherapy in the NHS

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Hip fracture is a serious, life-changing injury that can affect older people, and is the commonest reason for them to need emergency anaesthesia and surgery. The Physiotherapy Hip Fracture Sprint Audit (PHFSA) was the biggest ever audit of UK physiotherapy, and has implications for physiotherapists working in many settings.

Key recommendations

Early mobilisation

  • Collaborative multidisciplinary working is needed to ensure that pain, hypotension and delirium do not hold back early progress in physiotherapy.
  • Patients should be helped to get up by the day after surgery – such ‘mobilisation’ is key to patients’ wellbeing and avoidance of complications such as delirium, deconditioning and pressure damage. This mobilisation is just one element of the physiotherapy provided to patients, but it is the key measure that the National Hip Fracture Database (NHFD) will use to drive forward local quality improvement after Hip Sprint.
  • Local therapy teams should review how they record patients’ progress, so that there is clear communication of patient outcomes to multidisciplinary team (MDT) colleagues and correct reporting to the NHFD.

Intensive rehabilitation

  • Hip fracture programmes should invest in early intensive rehabilitation to maximise the number of people who can be discharged directly home from the acute orthopaedic ward.
  • Hospital physiotherapy teams should put in place systems to ensure that more intense rehabilitation includes attention to strength, balance and endurance, as well as mobility.
  • Physiotherapists should consider how they are teaching and working with colleagues, as Hip Sprint found little evidence that therapy work is being delegated to other staff; a missed opportunity for multidisciplinary working.

Local governance and quality improvement

  • Physiotherapists, surgeons, anaesthetists, orthogeriatricians and nurses should all attend monthly hip fracture programme clinical governance meetings.
  • Physiotherapists, surgeons, anaesthetists, orthogeriatricians and nurses should review their own unit’s Hip Sprint data at the NHFD and agree on a local quality improvement action plan.
  • Staffing levels affect patient care, especially after the first postoperative day and at weekends, and physiotherapists should continue the transparent approach developed in Hip Sprint to highlight concerns if staffing limits their ability to deliver care as per NICE recommendations.

Recovery from hip fracture serves as an excellent example of the challenges faced by frail and older patients, and by the multidisciplinary teams (MDTs) who seek to restore them to their previous mobility, independence and quality of life. For this reason, the Royal College of Physicians' (RCP's) National Hip Fracture Database (NHFD) and the Chartered Society of Physiotherapy (CSP) collaborated in this ‘Hip Sprint’ audit in 2017.

Findings of the Hip Sprint audit

  • 68% of patients got out of bed on the day after surgery but 7% of sites achieved this for fewer than half of their patients.
  • Patients averaged 2 hours of physio in the first week after surgery but 43% missed a day’s therapy as no physio was available.
  • 21% of home rehab started within 1 week of discharge but 10% of community physios had no handover from the hospital team.
  • 20% of services provided physio on more than 4 days of the patient's first week at home but patients waited an average of 15 days to start therapy at home.

Key findings and recommendations in this report were, where possible, mapped to NICE guidance (CG124).

Who's involved