Abstract：
BACKGROUND: Appropriate care and rehabilitation following surgery for fragility hip fractures in older adults is associated with better outcomes and a greater likelihood of achieving pre-injury functioning. Clinical guidelines specifically for the post-operative care and rehabilitation of patients with hip fractures are scarce; as such, country-specific protocols benchmarked against established guidelines are essential given the wide variation in cultures and beliefs, clinical practice and diverse healthcare systems in Asia. We aimed to provide clinically relevant recommendations for post-operative fragility hip fracture care and rehabilitation to improve patient outcomes and prevent subsequent fractures in Thailand.
METHODS: A targeted literature review was conducted to identify key evidence on various elements of post-hip fracture care and rehabilitation. Further discussions at a meeting and over email correspondence led to the development of the recommendations which amalgamate available evidence with the clinical experience of the multidisciplinary expert panel.
RESULTS: Our recommendations are categorized by one period domain - acute post-operative period, and five major domains during the post-operative period - rehabilitation, optimization of bone health, prevention of falls, nutritional supplementation, and prophylaxis for venous thromboembolism. A multidisciplinary approach should be central to the rehabilitation process with the involvement of orthopedists, geriatricians/internists, physiatrists, physical and occupational therapists, endocrinologists, pharmacists and nursing staff. Other key components of our recommendations which we believe contribute to better functional outcomes in older patients undergoing hip fracture surgery include comprehensive pre-operative assessments, early surgery, goal setting for recovery and rehabilitation, early mobilization, medication optimization, tailored exercise plans, adequate coverage with analgesia, assessment and appropriate management of osteoporosis with due consideration of the fracture risk, fall prevention plans, and nutritional assessment and support. Patients and their caregivers should be a part of the recovery process at every step, and they should be counseled and educated appropriately, particularly on the importance of adherence to their rehabilitation plan.
CONCLUSIONS: We have provided guidance on the critical domains of clinical care in the post-operative setting to optimize patient outcomes and prevent fracture recurrence. Our recommendations for post-operative care and rehabilitation of older adults with hip fracture can serve as a framework for hospitals across Thailand.
METHODS: A targeted literature review was conducted to identify key evidence on various elements of post-hip fracture care and rehabilitation. Further discussions at a meeting and over email correspondence led to the development of the recommendations which amalgamate available evidence with the clinical experience of the multidisciplinary expert panel.
RESULTS: Our recommendations are categorized by one period domain - acute post-operative period, and five major domains during the post-operative period - rehabilitation, optimization of bone health, prevention of falls, nutritional supplementation, and prophylaxis for venous thromboembolism. A multidisciplinary approach should be central to the rehabilitation process with the involvement of orthopedists, geriatricians/internists, physiatrists, physical and occupational therapists, endocrinologists, pharmacists and nursing staff. Other key components of our recommendations which we believe contribute to better functional outcomes in older patients undergoing hip fracture surgery include comprehensive pre-operative assessments, early surgery, goal setting for recovery and rehabilitation, early mobilization, medication optimization, tailored exercise plans, adequate coverage with analgesia, assessment and appropriate management of osteoporosis with due consideration of the fracture risk, fall prevention plans, and nutritional assessment and support. Patients and their caregivers should be a part of the recovery process at every step, and they should be counseled and educated appropriately, particularly on the importance of adherence to their rehabilitation plan.
CONCLUSIONS: We have provided guidance on the critical domains of clinical care in the post-operative setting to optimize patient outcomes and prevent fracture recurrence. Our recommendations for post-operative care and rehabilitation of older adults with hip fracture can serve as a framework for hospitals across Thailand.
摘要：
背景：老年人脆性髋部骨折手术后的适当护理和康复与更好的预后和更大的实现损伤前功能的可能性相关。专门针对髋部骨折患者的术后护理和康复的临床指南很少；因此，鉴于文化和信仰的广泛差异，以既定准则为基准的针对特定国家的协议至关重要，亚洲的临床实践和多样化的医疗保健系统。我们旨在为术后脆性髋部骨折的护理和康复提供临床相关建议，以改善患者的预后并预防泰国的后续骨折。
方法：进行了有针对性的文献综述，以确定髋部骨折后护理和康复各要素的关键证据。在会议和电子邮件通信中进行的进一步讨论导致了建议的发展，这些建议将现有证据与多学科专家小组的临床经验相结合。
结果：我们的建议按一个时期分类-急性手术后时期，术后期间的五个主要领域-康复，优化骨骼健康，防止跌倒,营养补充,和静脉血栓栓塞的预防。在骨科医生的参与下，多学科方法应该是康复过程的核心，老年病学/内科医生，理疗师,物理和职业治疗师，内分泌学家,药剂师和护理人员。我们认为有助于老年髋部骨折手术患者改善功能的建议的其他关键组成部分包括全面的术前评估，早期手术,恢复和康复的目标设定，早期动员,药物优化，量身定制的锻炼计划，足够的镇痛覆盖率，在适当考虑骨折风险的情况下评估和适当管理骨质疏松症，跌倒预防计划，营养评估和支持。病人和他们的照顾者应该是恢复过程中每一步的一部分，他们应该得到适当的咨询和教育，特别是坚持他们的康复计划的重要性。
结论：我们为术后临床护理的关键领域提供了指导，以优化患者预后并防止骨折复发。我们对髋部骨折老年人的术后护理和康复的建议可以作为泰国各地医院的框架。
方法：进行了有针对性的文献综述，以确定髋部骨折后护理和康复各要素的关键证据。在会议和电子邮件通信中进行的进一步讨论导致了建议的发展，这些建议将现有证据与多学科专家小组的临床经验相结合。
结果：我们的建议按一个时期分类-急性手术后时期，术后期间的五个主要领域-康复，优化骨骼健康，防止跌倒,营养补充,和静脉血栓栓塞的预防。在骨科医生的参与下，多学科方法应该是康复过程的核心，老年病学/内科医生，理疗师,物理和职业治疗师，内分泌学家,药剂师和护理人员。我们认为有助于老年髋部骨折手术患者改善功能的建议的其他关键组成部分包括全面的术前评估，早期手术,恢复和康复的目标设定，早期动员,药物优化，量身定制的锻炼计划，足够的镇痛覆盖率，在适当考虑骨折风险的情况下评估和适当管理骨质疏松症，跌倒预防计划，营养评估和支持。病人和他们的照顾者应该是恢复过程中每一步的一部分，他们应该得到适当的咨询和教育，特别是坚持他们的康复计划的重要性。
结论：我们为术后临床护理的关键领域提供了指导，以优化患者预后并防止骨折复发。我们对髋部骨折老年人的术后护理和康复的建议可以作为泰国各地医院的框架。
