An Evidence-Based Exercise Program for Total Hip Arthroplasty Rehabilitation in Geriatric Patients with Femoral Neck Fractures: A Delphi Study.

BACKGROUND

Femoral neck fractures (FNFs) represent a significant public health challenge in aging populations. Total hip arthroplasty (THA) has emerged as the preferred surgical management for active geriatric patients over 60 years old. However, standardized, evidence-based rehabilitation protocols specifically tailored to the Chinese healthcare context remain limited.

PURPOSE: This study aimed to develop and validate an expert consensus-based exercise program for geriatric Chinese patients with FNFs undergoing THA, addressing gaps in pre-operative preparation, post-operative care, and home-based rehabilitation continuity.

PATIENTS AND

METHODS

Using the Model for Evidence-Based Practice Change framework, we conducted a multi-phase study: (1) needs assessment through semi-structured interviews with 21 healthcare professionals; (2) systematic evidence synthesis from 16 high-quality sources; and (3) iterative refine the program through two-round Delphi consultation with 15 multidisciplinary experts from orthopedics, rehabilitation medicine, nursing, and management.

RESULTS

The Delphi process demonstrated high expert engagement (response rates: 93.75% round 1, 100% round 2) and acceptable authority (Cr=0.917). Expert coordination improved across rounds, with Kendall's W values increasing from 0.244-0.287 (round 1) to 0.104-0.371 (round 2) for different item levels, and coefficient of variation decreasing from 0.00-0.64 to 0.00-0.14. 11 items with CV>0.25 were eliminated after round 1, reflecting initial variability in expert opinions. The iterative consensus process yielded a four-domain program structure: (1) in-hospital pre-operative rehabilitation, (2) in-hospital post-operative rehabilitation, (3) out-of-hospital home-based rehabilitation, and (4) follow-up care. The final program comprises 4 first-level items, 17 second-level items, and 63 third-level items with specific operational parameters including timing, frequency, intensity, and methods adapted to Chinese clinical practice patterns.

CONCLUSION

Through rigorous expert consensus methodology, this study developed a comprehensive, multi-level rehabilitation framework for geriatric FNFs patients undergoing THA in China, achieving acceptable agreement on program content and feasibility. As consensus-based findings, prospective validation is essential to establish clinical effectiveness and guide evidence-based implementation.