"Mind the Gap": Brazilian Physiotherapists Are Not Implementing Early Mobilization Interventions for Postoperative Patients With Hip Fractures.

BACKGROUND AND PURPOSE: Early mobilization, such as standing and walking within the first day after surgery, is crucial to enhance recovery after a hip fracture, yet its implementation remains a challenge. This paper aims to understand the Brazilian physiotherapists' (PTs) knowledge and practices regarding early mobilization after hip fracture repair.

METHODS

An online survey was conducted from September 1, 2022 to May 31, 2023 with PTs involved in postoperative care for hip fracture patients. Participants were recruited via social media and email, and answered questions assessing their knowledge and typical practices regarding the timing of early mobilization (standing and ambulation) post-hip fracture surgery. Responses were classified from the most to least associated with best practices: since the first day, the second day, and the third day or later. They also reported professional and organizational aspects related to their background, training, and work practice. Ordinal regression models identified variables associated with better knowledge and/or implementation of early mobilization.

RESULTS

Of the participants, 234 completed questions on organizational and professional aspects, 169 on standing, and 155 on ambulation. PTs working in orthogeriatric teams showed best knowledge of standing (OR = 1.92, P = .048) and ambulation (OR = 1.88, P = .039). Working in private hospitals (OR = 2.32, P = .010), assisting fewer than 10 patients per day (OR = 1.91, P = .041), and using mobility assessments (OR = 1.86, P = .084) were associated with better knowledge of early mobilization. Not relying on surgeon authorization (OR = 2.27, P = .015) and assisting fewer than 10 patients per day (OR = 2.26, P = .011) were associated with better implementation of standing and/or ambulation practices. Attending training on post-hip fracture rehabilitation was significantly associated with better standing practice (OR = 1.91, P = .031).

CONCLUSIONS

Multiple modifiable factors are associated with knowledge and practice of early mobilization. These findings may help practitioners and managers identify the shortcomings of current care provision, as well as the barriers and challenges to improving best practices in rehabilitation.