Abstract
Introduction: The Irish Hip Fracture Database (IHFD) is a national clinical audit that measures standards of care for hip fracture patients across trauma sites in Ireland. Early mobilisation is considered to be one of the most influential modifiable factors for improving outcomes post hip fracture in older adults. The development of a mobility standard within the IHFD has provided a framework for physiotherapists to provide early mobilisation for hip fracture patients nationally.
Method: Each of the sixteen trauma sites in Ireland enter data into the IHFD. The data is analysed by NOCA and published in annual reports. 2018 saw the commencement of reporting mobilisation post-operatively as part of the IHFD. In 2022, a formal clinical standard for mobilisation, titled Irish Hip Fracture Standard seven (IHFS 7) was introduced. The standard requires patients to complete a stand on the day of or day after surgery by a physiotherapist. Functional measures including the Cumulative Ambulatory Score (CAS) and the New Mobility Score (NMS), are also recorded to guide goal-orientated rehabilitation and quality care for this cohort. IHFS 7 has also led to the formation of a physiotherapy network, designed to encourage shared learning and knowledge for therapists.
Results: Mobility rates have increased from 7% in 2018 to 87% in 2023 on day one post surgery. Weekend physiotherapy service provision have also increased based on organisational surveys completed nationally. The majority of Irish hip fracture patients demonstrate low functional ability pre-fracture (52%), as graded by the NMS, with only 24% achieving independent mobility by day of discharge.
Conclusion: The introduction of IHFS 7 has been successful in supporting early mobilisation. Work needs to continue in enhancing completion rates for our functional outcome measures and evaluating barriers to mobility in the early post-operative phase.