A simple intervention to improve day 1 mobility following fragility hip fracture: the Cardiac Chair Position : a single-centre cohort study of 270 patients.

Abstract

Fragility hip fractures are a growing concern, increasing year on year by just over 1%. These injuries carry high mortality rates and often result in poor functional outcomes, especially in frail patients. Early mobilization after surgery has been linked to better survival and shorter hospital stays. While Enhanced Recovery After Surgery (ERAS) protocols are well established in elective orthopaedics, their application in hip fracture care remains limited due to the frailty of this patient group. The Cardiac Chair Position (CCP), originally used in cardiac surgery, may support early mobilization by helping patients transition from supine to standing. This study evaluated the impact of incorporating CCP into day 1 rehabilitation for hip fracture patients. This observational cohort study compared two six-month periods: June to November 2019 (standard care) and June to November 2021 (standard care plus CCP). A total of 270 patients aged 65 years and older with neck of femur fractures from low-energy trauma were included. Patients were divided into two groups: those who received standard bed exercises, and those who also used the CCP. Researchers collected data on day 1 mobility, postural hypotension, inpatient mortality, 30-day survival, length of hospital stay, and discharge destination. No significant differences were observed in postural hypotension, mortality, length of stay, or discharge destination. However, the CCP group showed significantly improved day 1 mobility with an increased proportion of patients demonstrating the ability to push-off the bed, stand and step, transfer to a chair, and walk. Although CCP did not affect survival or hospital stay, it did enhance day 1 mobility. Given its simplicity, CCP is a promising addition to hip fracture rehabilitation. Further studies, including randomized trials and cost-effectiveness assessments, are needed to confirm its broader benefits. This research underscores the importance of early mobilization in elderly patients with fragility fractures.