Weight-bearing and mobilisation timing after hip fracture surgery in older adults: an international survey of clinicians' perspectives

Abstract

PURPOSE: This exploratory study aimed to describe international variations in mobilisation timing and weight-bearing after hip fracture surgery, focusing on differences between high-income countries (HICs) and low- and middle-income countries (LMICs) and identify the possible reasons for these variations. METHODS: This international cross-sectional study was administered through an online, English-language, self-reported questionnaire. Healthcare professionals from various multidisciplinary teams were invited to participate via professional organisations, including the Fragility Fracture Network, social media, and through snowballing from key individual stakeholders. RESULTS: A total of 389 healthcare professionals from 71 countries participated in the survey. Among them, 72.5% prescribed mobilisation the day after surgery, higher in HICs (79.1%) than LMICs (56.3%). Of those who prescribed early mobilisation, 38.3% achieved it 76-100% of the time, more frequently in HICs (42.9%) than LMICs (21.9%). Additionally, 73.5% prescribed unrestricted weight-bearing, also more common in HICs (86.3%) than LMICs (41%). For those who prescribed unrestricted weight-bearing, 50.4% achieved it 76-100% of the time, with HICs at 54.0% and LMICs at 31.9%. Multiple patient-related, process-related, and structure-related barriers were reported, with structure-related barriers more common in LMICs than HICs, underscoring the global complexities in implementing these practices. CONCLUSION: This study offers insights into global variations in the timing of mobilisation and weight-bearing after hip fracture surgery in older adults. It reveals disparities in postoperative services and resources between HICs and LMICs. Additionally, it establishes a foundation for future research and underscores the importance of international collaboration and knowledge sharing in enhancing postoperative care services.