Exercise modalities and outcome measures used in older adults after hip fracture with or without signs of cognitive impairment: a national cross-sectional e-survey of 90 out of 98 municipalities in Denmark

OBJECTIVE: To investigate rehabilitation settings, exercise modalities, and assessments provided post-discharge to older adults with hip fracture with and without signs of cognitive impairment.

DESIGN: National cross-sectional e-survey.

SUBJECTS: Rehabilitation managers and development physiotherapists from all 98 Danish municipalities.

METHODS: Information was collected on rehabilitation after discharge across four settings: 24-h-care, home-based care, outpatient-healthcare-centers, and nursing-home-facilities.

RESULTS: Ninety municipalities (92%) responded. About half used standardized screening tools to guide rehabilitation, but only 4% screened for cognitive impairment. Rehabilitation was typically delivered by physiotherapists 1-2 times/week, lasting 5-12 weeks, with 24-h-care and nursing-home facilities settings offering shorter but more frequent sessions. Common exercise modalities included strengthening, balance, and functional tasks, where these were more used in hip fracture than hip fracture with signs of cognitive impairment. Patient-Reported-Outcome-Measures (PROMs) were infrequently used; the Patient-Specific-Functional-Scale and Numerical-Rating-Scale were most often used. Cognitive PROMs were rarely applied, except the Montreal-Cognitive-Assessment at 24-h-care. Performance-based tests were more widely used, particularly the 30s-sit-to-stand and Timed Up&Go tests.

CONCLUSION: The survey had a high response rate. Few municipalities used cognitive screening tests and pain scales whereas performance-based testing was more predominant. The preferred exercise modality was functional exercise, used more often for patients with hip fracture than those with hip fracture and signs of cognitive impairment.