An observational study of walking aid use after discharge following ...

An observational study of
walking aid use after
discharge following hip
fracture
Susie Thomas
Flinders University & Flinders Medical Centre

Falls and hip fracture
There is an established relationship between
hip fractures and falls in older people:
– up to 90% of hip fractures occurring as the
result of a fall
– up to 53% of people falling again in the six
p p p g g
months following their hip fracture

A major public health h issue
Ageing population
+ ↑ Hip Fractures
Population growth 1.7 million (1990)
323 million (2010) 6.3 million (2050)
1.6 billion (2050)

Recovery yfrom hip pfracture
(or not…)
– Up to 36% of patients die in first year post
fracture
– 60% of patients do not regain pre-fracture level el
of mobility
– Only 40% can perform ADL’s independently at
12 months

Physical Function Rehabilitation
PT has an important role:
mobility; function; falls prevention

Research ea
Questions
In the first six months following hip fracture:
1. What is the pattern of walking aid use?
2. How are walking aids obtained and used? Is this use
appropriate?
3. Are they reviewed by a suitably qualified health
professional during this period?

Study Design
Prospective longitudinal observational study on a
sub-set of hip fracture patients t recruited into the
INTERACTIVE trial

INTERACTIVE trial
Individual Nutrition Therapy and Exercise
Regime: AControlled Trial of Injured
Vulnerable Elderly
(NHMRC Project Grant 426758)

Eligibility
ibili
Inclusion criteria
Exclusion criteria
Proximal Femur Fracture
>70 years
MMSE score ≥ 18/30
BMI 18.5 kg/m 2 - 35 kg/m 2
Residing g within local service
boundaries
Residing in residential care
Palliative or malignancy
Surgeons orders - unable to
mobilise post surgery
Non English Speaking
Not medically stable within 14 days
of surgery

Results
101 participants
enrolled onto
INTERACTIVE trial
(June 2007- Jan 2009)
Withdrew (n=4)
Deceased (n=2)
95 participants
followed for full 6/12

Results
• 92% discharged with a wheeled frame
• 86% were not aware of any ygoals
• 94% had no follow up arranged

Results
• 78 (82%) participants changed their walking aid
– On average 8.2 weeks (SD 6.1) post-operatively
• 32% using an inappropriate aid or using it incorrectly
• Pre-morbid walking aid at 6 months post fracture:
– 40% had not returned to their indoor aid
– 50% had not returned to their outdoor aid

Summary
1. Lack of walking aid review by a trained health
professional
2. High number of participants making inappropriate
decisions about which walking aid to use
3. Considerable safety implications in a group already
y p g p y
at high risk of falls

Publication:
Thomas S, Halbert J, Mackintosh S, Cameron I D, Kurrle S,
Whitehead C, Miller M, Crotty M. Walking aid use after discharge
following hip fracture is rarely reviewed and often inappropriate: an
observational study. Journal of Physiotherapy 2010;56(4):267-272.

Acknowledgements:
Ak e
• Co-authors
– Dr Julie Halbert
– Dr Shylie Mackintosh
– Prof Ian Cameron
– Assoc Prof Susan Kurrle
– Assoc Prof Craig Whitehead
– Dr Michelle Miller
– Prof Maria Crotty
• Participants of projects
• Funding
– NHMRC Priority Public Health Research Scholarship
– NHMRC Project Grant (INTERACTIVE trial)