Perioperative interventions to improve early mobilisation and physical function after hip fracture

Perioperative interventions, such as analgesia regimens, timing of surgery and type of anaesthesia, are recommended in clinical practice guidelines to address barriers to early mobilisation and optimise physical function outcomes. 

The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative interventions on achieving early mobilisation and improving physical function after hip fracture.

Twenty-eight studies were included in this systematic review and meta-analysis, in which participated a total of 8,192 patients with a fractured proximal femur and a mean age of 80 years. Interventions were grouped into six categories: analgesia, pathways and models of care, rehabilitation delivery modes, surgical protocols, nutritional supplements and clinical supervision.

The results of this study indicated that:

• TENS analgesia may provide a moderate improvement to physical function, and pathways and models of care may provide a small improvement in function, particularly orthogeriatric models.
• Some studies supported improved early mobilisation for multidisciplinary rehabilitation delivery modes compared to usual care and direct clinical supervision of physiotherapists compared to usual reflective supervision.
• Multiple studies indicated less clear results for peripheral nerve blocks, and ERAS care pathways on early mobilisation and physical function, and orthogeriatric models and recumbent bike cycling on function.
• Single studies evaluating pre-emptive analgesia and intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, indicated benefits for postoperative mobilisation and function.
• No improvement in physical function was identified from occupational therapy training rehabilitation delivery modes and nutritional supplements.

The authors concluded that many barriers to early mobilisation are potential amenable to perioperative interventions. The delivery of these perioperative interventions varies substantially between hospital sites and their impact on the ability to mobilise early postoperatively and restoration of physical function is not yet well understood. Future aetiologic studies are required to understand and model the causal mechanisms by which early mobilisation and physical function after hip fracture can be improved by perioperative interventions.

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