What factors affect early mobilisation following hip fracture surgery: A scoping review

Abstract

Objectives Identify and evaluate factors affecting early mobilisation on the day following hip fracture surgery. Design Mixed methods, scoping review. Data sources MEDLINE, AMED, CINAHL, APA PsycINFO, APA PsycArticles, ISRCTN, Clinical Trials registry and grey literature accessed in November 2022 with publication dates between 2001 and November 2022. Eligibility criteria English language publications that: 1. Include patient populations who sustain a fragility hip fracture managed surgically 2. Include patient populations who are mobilised out of bed on the day following their hip fracture surgery 3. Report factors which influence the ability to undergo early mobility postsurgery Data extraction and synthesis One reviewer screened all titles and abstracts for inclusion. Two reviewers performed data extraction and quality assessments using the relevant Critical Appraisal Skills Programme tools and the Mixed Methods Appraisal Tool. Results 3337 papers were identified, of which 23 studies were eligible for review, representing 210 811 patients. The heterogeneity in the types of study included, the definition of early mobilisation and the outcome measures used precluded meta-analysis. 13 factors were identified as having an effect on whether people were mobilised on day 1 post-hip fracture surgery, grouped into 5 principal themes: (1) healthcare setting or worker-related factors, (2) patient psychological factors, (3) acute patient health factors, (4) non-acute patient health factors and (5) surgical factors. Conclusions There was a paucity of robust research investigating day 1 mobilisation post-hip fracture surgery. Each of the five factors identified is potentially modifiable through service improvement change and innovation strategies. There is an opportunity to explore how service provision change could be implemented to improve outcomes for all patients following hip fracture surgery demonstrating the clinical and cost benefits of these changes against the cost of delivering the change.