Proximal femoral fracture (PFF) is a major cause of morbidity and mortality in the elderly population (Khasragi, Christmas, Meers, & Wenz, 2005). Referred to as a ‘hip fracture’ in laypersons terms, PFF occurs in the “region between the femoral head and 5 centrimeters below the lesser trochanter” (National Clinical Guideline Center [NCGC], 2011, p. 6). In industrialised countries, the mean age of people sustaining hip fracture is 80 years old, demonstrating hip fracture is predominantly a phenomenon of later life, and 80% are female (Handoll, Camerson, Mak, & Finnegan, 2009). An estimated 1.26 million hip fractures occurred in adults in 1990. With the projected increase in population over 65 years of age, predictions range from 7.3, to 21.3
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“The majority of PFF patients will undergo surgery, since the benefits of early fixation/replacement to facilitate rapid post-operative mobilization, outweigh the risks of surgery and avoid poor outcomes associated with long-term immobilization due to non-operative management” (Fernandez, Griffin, & Costa, 2015, p. 166). For the patients themselves, sustaining a hip fracture is a potentially disasterous event. Fernandez et al. (2015) state mortality rates are approximately 30% in the first 12 months following surgical intervention, most due to the high prevalence of comorbidities in this patient group. These commonly include diabetes, impaired mobility/balance and cardiovascular disease, with approximately 40% also suffering cognitive impairment (Fernandez et al., 2015). Hip fracture is therefore by no means an exclusively surgical concern. “Effective treatment requires a comprehensive, multidisciplinary approach covering the full time course of the condition from presentation to subsequent follow-up, including the transition from hospital to community” (NCGC, 2011, p. …show more content…
Regular discussion regarding treatment goals is facilitated through weekly formal meetings between the MDT, the patient and their family. Logic suggests that this comprehensive team approach provides the highest level of patient care, however, the evidence still remains ambiguous. A Cochrane review by Handoll et al. (2009) examined the effects of multidisciplinary rehabilitation (MDR), in either inpatient or ambulatory care settings, for older patients with hip fracture. 13 trials were included which compared 2498 older, usually female, patients who had undergone surgery for hip fracture, with controls who received “usual care” by an orthopedic or medical team. A ‘poor outcome’ was defined as death or deterioration of functional status, leading to increased dependency in the community or admission to institutional care (Handoll et al., 2009). It is noted by the authors that characteristics of multidisciplinary and ‘usual’ care varied significantly between all included trials. Therefore, the various aspects of clinical heterogeneity must be considered when appraising the findings of this review. Pooled results show no statistically significant difference between intervention and control groups for ‘poor outcome’, with a
“The majority of PFF patients will undergo surgery, since the benefits of early fixation/replacement to facilitate rapid post-operative mobilization, outweigh the risks of surgery and avoid poor outcomes associated with long-term immobilization due to non-operative management” (Fernandez, Griffin, & Costa, 2015, p. 166). For the patients themselves, sustaining a hip fracture is a potentially disasterous event. Fernandez et al. (2015) state mortality rates are approximately 30% in the first 12 months following surgical intervention, most due to the high prevalence of comorbidities in this patient group. These commonly include diabetes, impaired mobility/balance and cardiovascular disease, with approximately 40% also suffering cognitive impairment (Fernandez et al., 2015). Hip fracture is therefore by no means an exclusively surgical concern. “Effective treatment requires a comprehensive, multidisciplinary approach covering the full time course of the condition from presentation to subsequent follow-up, including the transition from hospital to community” (NCGC, 2011, p. …show more content…
Regular discussion regarding treatment goals is facilitated through weekly formal meetings between the MDT, the patient and their family. Logic suggests that this comprehensive team approach provides the highest level of patient care, however, the evidence still remains ambiguous. A Cochrane review by Handoll et al. (2009) examined the effects of multidisciplinary rehabilitation (MDR), in either inpatient or ambulatory care settings, for older patients with hip fracture. 13 trials were included which compared 2498 older, usually female, patients who had undergone surgery for hip fracture, with controls who received “usual care” by an orthopedic or medical team. A ‘poor outcome’ was defined as death or deterioration of functional status, leading to increased dependency in the community or admission to institutional care (Handoll et al., 2009). It is noted by the authors that characteristics of multidisciplinary and ‘usual’ care varied significantly between all included trials. Therefore, the various aspects of clinical heterogeneity must be considered when appraising the findings of this review. Pooled results show no statistically significant difference between intervention and control groups for ‘poor outcome’, with a