Factors Associated With an Immediate Weight-Bearing and Early Ambulation Program for Older Adults After Hip Fracture Repair

Objective: To evaluate baseline characteristics and in-hospital factors associated with nonadherence with an immediate weight-bearing and early ambulation (IWB-EA) program after hip fracture (HF) surgery. Design: Prospective inception cohort study. Setting: Ortho-geriatric unit in an acute care hospital. Participants: Older adults (N=469) admitted with an osteoporotic HF who underwent surgery. Interventions: Immediate weight-bearing and assisted ambulation training on the first postoperative day (all patients). Main Outcome Measure: Proportion of subjects who adhered to the IWB-EA protocol within 48 hours of surgery. Results: A total of 366 patients (78%) bore weight and ambulated within 48 hours (weight-bearing [WB] group) while the others did not adhere to the protocol (nonweight-bearing [NWB] group). Subjects in the NWB group were significantly older, were more cognitively and functionally impaired, and presented a higher comorbidity at baseline. A higher proportion of subjects in the NWB group (42.7%) than the WB group (23.5%; P<.001) underwent surgery on a preholiday day. In multivariate analysis, having surgery on Friday or a preholiday day (the day before a public holiday) remained the most influent variable related to nonadherence to the IWB-EA protocol (odds ratio=2.5; 95% confidence interval = 1.6-4.0; P<.001). Conclusions: This study establishes that IWB-EA is feasible in a high proportion of patients after surgical stabilization of HF. Neither cognitive impairment nor high comorbidity influenced significantly the adherence to the protocol, indicating that IWB-EA may be offered to all Unselected population of the elderly with HF. The day of surgery (eg, preholiday or not) was the only variable influencing the participation to the IWB-EA protocol, suggesting the importance of maintaining the same standard of daytime care every day of the week.