Understanding Barriers to Early Rehabilitation Following the Surgery for Fragility Hip Fractures: A Single-Centre Audit

Introduction Hip fractures are amongst the most common reasons for geriatric patients' admission to the hospital; recovery of the hip fracture patient can be enhanced by an early rehabilitation program, which should start from the time of admission. This audit aims to study the hip fracture physiotherapy rehabilitation program at a local hospital to ensure compliance with the national guidelines and to identify any potential barriers to early mobilisation after a hip fracture operation. Methods The audit was approved by the trust's audit office. A retrospective study in the Queen Elizabeth The Queen Mother Hospital in Margate, Kent, UK, has been conducted including 113 patients admitted from April to August 2023 to our local hospital; the patients were screened for the inclusion and exclusion criteria, and data collection started regarding the admitting wards and their physiotherapy assessments including the time they were first assessed by a physiotherapist and the time of first mobilisation after the hip fracture operation and any identified barriers to early mobilisation. Results There were 113 patients who underwent hip fracture surgery, including 23 males and 90 females. The mean age of the participants was 82.7 years. Ninety-three percent (n=106/113) of the patients were seen by a physiotherapist on the day or the day following the surgery for their hip fracture. Amongst the admitted patients, 40% (n=46/113) experienced delayed mobilisation. The reason for the delay was post-operative delirium (n=15/46), low haemoglobin (n=12/46), pain (n=10/46), dementia (n=2/46) and no documented reason (n=7/46). Conclusion The study outcomes emphasise the importance of admitting hip fracture patients into specialised orthopaedic wards. The study identified post-operative delirium, low haemoglobin, pain and pre-existing dementia as factors that delay rehabilitation. Most of these factors are preventable or manageable, which can facilitate early rehabilitation and subsequently hospital discharge.