Integrated rehabilitation shows effectiveness in treating hip fractures

In treating people with hip fractures, a new short—and long-term rehabilitation approach called “Fragility Fracture Integrated Rehabilitation Management (FIRM)” has increased the proportion of patients who become able to walk later.

The approach integrates physical therapy, occupational therapy, fall prevention education, post-discharge care, and community linkages.

Compared to traditional rehabilitation, which focuses on physical exercise and simple gait training, FIRM is a comprehensive, standardized program and multidisciplinary approach that includes orthopedic, geriatric, rehabilitation specialists, physical therapists, occupational therapists, dietitians, clinical psychologists, and social workers.

It is an integrated rehabilitation program that establishes a plan for physical therapy, occupational therapy (training for performing daily activities), nutrition management, prevention of complications (pressure ulcers, pneumonia, urinary tract infections), control of pain and delirium, and community linkage through a comprehensive assessment team meeting. The plan is periodically evaluated and monitored.

Seoul National University Bundang Hospital (SNUBH) said Monday that a research team led by Professor Lim Jae-young of the Department of Rehabilitation Medicine randomly assigned 203 patients 65 and older who underwent hip fracture surgery to FIRM treatment (108 patients) and conventional rehabilitation (95 patients) and followed them for one year.

The researchers developed FIRM according to international standard practice guidelines and Korean conditions to help fracture patients improve their motor function and quality of life in daily activities, including walking, and reduce mortality. They analyzed its effectiveness in a multicenter clinical study. Gait function was assessed using the Koval (lower is better) and FAC (higher is better) scales and analyzed as the percentage of independent walking at rehabilitation admission, discharge, and at three, six, and 12 months postoperatively, as well as pre-fracture gait status.

The analysis showed that the change in Koval score in the FIRM group over one year was -4.13 points, which was greater than the change in the usual care group (-3.22 points), and the FAC score increased by 3.37 points in the FIRM group, compared to 2.56 points in the usual care group. At the 12-month follow-up, FIRM also had a higher rate of independent ambulation of 76.8 percent compared to 56.0 percent in the usual care group and a higher rate of return to pre-fracture gait of 81.2 percent compared to 62.0 percent in the control group.

The researchers attributed this to the fact that FIRM provided intensive, personalized care with a multidisciplinary approach instead of conventional rehabilitation, which focuses primarily on basic exercises. Notably, the program supported early discharge based on a standardized, comprehensive assessment and worked with the community to ensure continued care after discharge.

According to the Ministry of Health and Welfare, falls are a leading health threat to older adults, affecting about 20 percent of them. Fragility fractures caused by falls are more common in winter, especially in the hip joint, which is a common fracture in people over 75, and it remains a major social problem, with many failing to return to their previous level of function or even dying.

Hip fractures require long-term follow-up care to return to normal activities after surgery, and comprehensive and systematic rehabilitation, especially in the early postoperative period, can reduce complications and lower disability. However, in Korea, specialized rehabilitation is not provided in acute hospitals after fragility fracture surgery, and many patients are discharged from the hospital without receiving adequate rehabilitation or are transferred to a follow-up hospital or nursing home.

“Integrated multidisciplinary management of geriatric diseases is emerging as an important healthcare issue in an ultra-aging society, which will further increase the interest and demand for other novel rehabilitation methods,” Professor Lim said. “The institutional adoption of multidisciplinary rehabilitation is necessary to reduce the functional disability and mortality of elderly fracture patients while reducing socioeconomic costs, and we hope that our findings will serve as a foundation.”