Tohoku J. Exp. Med., 2018 December, 246(4)

Early Out-of-Bed Functional Exercise Benefits Elderly Patients Following Hip Fracture: A Retrospective Cohort Study

YEYANG WANG,1 MINGSEN WANG,2 HONGDONG CHEN,3 GUITAO LI,1 WENJUN LI,4 JUNNAN LUO5 and HUANBIN LI2

1Department of Spine Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
2Department of Orthopedic, Traditional Chinese Medicine Hospital of Puning City, Orthopaedic Hospital of Puning City, Puning, China
3School of Basic Medical Science, Southern Medical University, Guangzhou, China
4Department of Joint Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
5Department of Spine Surgery, Guangzhou First People's Hospital, Guangzhou, China

Hip fracture is a worldwide medical problem with devastating consequences. Older adults are at higher risk for complications and have more mobility limitation. The aim of this study was to assess the impact of delay in out-of-bed functional exercise on one-year mortality and functional outcomes for elderly patients with hip fracture in China. 1,022 cases of patients with hip fracture who were older than 75 were involved in this retrospective cohort study between 2007 and 2017. One-year mortality, follow up Activities of Daily Living (ADL) score, and Harris hip score were collected. Patients with hip fracture experienced an average of 2.9 days of in-bed functional exercise, 41.4% (n = 423) taken out-of-bed functional exercise within 2 days. A Cox proportional regression model showed that after adjustment for age, sex, cardiovascular disease, and urinary disease, delayed out-of-bed functional exercise (> 2 days) associated with higher one-year mortality (OR = 1.38, 95% confidence interval [CI]: 1.09 to 1.69). Ordinary least squares regression showed that delayed out-of-bed functional exercise associated with worsen ADL scores at 1-month (difference of −3.9 points, 95% CI: −6.4 to −1.7), although the long term ADL scores did not have increased. In addition, there were no associations between out-of-bed functional exercise timing and the Harris hip score at 12 months. In conclusion, in elderly patients with hip fracture in China, delayed out-of-bed functional exercise was not associated with improved Harris hip score, but it was associated with worsen ADL capacities at 1-month postoperatively and higher one-year mortality. The present study emphasizes the benefit of early out-of-bed exercise on the majority of elderly patients with hip fracture.

Key words —— activities of daily living; exercise training; hip fractures; mortality; retrospective study

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Tohoku J. Exp. Med., 2018, 246, 205-212

Correspondence: Mingsen Wang, Department of Orthopedic, Traditional Chinese Medicine Hospital of Puning City, Orthopaedic Hospital of Puning City, No. 27, Liusha Avenue, Puning 515300, China.

e-mail: wmingsen13@163.com