Physical Therapy Management of Older Adults With Hip Fracture

This APTA Orthopedics guideline covers physical therapy for older adults after a hip fracture across the whole episode of care: the hospital, skilled nursing, home and outpatient settings.

It names the measures physical therapists should use in every setting, including knee extension strength, a verbal pain scale, gait speed and the timed up-and-go test, and it gives physical therapists a role in interprofessional care: helping prevent delirium, managing pain, preventing pressure ulcers, assessing fall risk, making sure patients are evaluated for osteoporosis, and planning transitions between settings.

On treatment, patients must be helped out of bed and walking as soon as possible after surgery and at least daily after that, unless medically contraindicated. Physical therapists must provide structured exercise that includes progressive high-intensity strength, balance, weight-bearing and functional mobility training, and should offer more therapy if deficits remain 8 to 16 weeks after the fracture. Electrical stimulation may be used for quadriceps strengthening or pain when other approaches fall short.