in the hospital, a well-designed physical therapy program should focus on ambulation within the first 48 hours, strength training, balance and weight bearing exercises, and 60 minutes of super- vised therapy a day. All of these techniques have been proven to assist with a patient’s return to the PLOF. The most critical role of a physical therapist, however, is to help in the prevention of hip fractures. This is best performed by systematically screening patients seen in therapy for falls, and for those with osteoporosis risks. Seers, K., Crichton, N., Tutton, L., Smith, L. & Saunders, T. (2008). Effectiveness of relaxation for postoperative pain and anxiety: Randomized controlled trial. Journal of Advanced Nursing, Vol.62 (No.6). pp. 681-688. Lan, F., Ma, Y.H., Xue, J.X., Wang, T.L. & Ma, D.Q. (2012) Transcutaneous electrical nerve stimulation on acupoints reduces fentanyl requirement for postoperative pain relief after total hip arthroplasty in elderly patients. Minerva Anestesiol., 78(8):887-95. Nickinson, R.S., Board, T.N. & Kay, P.R. (2009). Post-operative anxiety and depression levels in orthopaedic surgery: A study of 56 patients undergoing hip or knee arthroplasty. J Eval Clin Pract, 15(2):307-10. National Institute of Mental Health. Signs and symptoms of depression. Retrieved from http://www.nimh.nih.gov/health/topics/depression/men-and-depression/signs-and- symptoms-of-depression/index.shtml Koeppel, B., (2013, March). New method of hip replacement wins favor with some surgeons. The Washington Post , retrieved from https://www.washingtonpost.com/ national/health-science/new-method-for-hip-replacement-wins-favor-with-some- surgeons/2013/03/25/15a9ec24-7ad1-11e2-a044-676856536b40_story.html Robinson, T.N. & Eiseman, B. (2008). Postoperative delirium in the elderly: Diagnosis and management. Clinical Interventions in Aging, 3(2):351-355. The American Geriatrics Society. (2016). AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons. Retrieved from http://www.americangeriatrics.org/health_care_ professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_ summary_of_recommendations Leung, F.W. & Schnelle, J.F. (2008). Urinary and fecal incontinence in nursing home residents. Gastroenterology Clinics of North America, 37(3):697-x.
While it is also important for every team member to screen for adequate pain control, the therapist will be asking the patient to increase activity more than the other staff members; therefore, is likely to see the need for increased pain management. While each of these conditions is typically managed medically, the therapist can contribute to the best care of the patient by performing early screening, as well as encouraging a regular schedule of exercise to help with both delirium and depression. The therapist can assist with pain management by using ice, encouraging regular ROM of the LE, explaining relaxation techniques, and using TENS. While Centers for Disease Control and Prevention (2015, September). Hip fractures among older adults. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html Schnell, S., Friedman, S.M., Mendelson, D.A., Bingham, K.W. & Kates, S.L.(2010). The 1-year mortality of patients treated in a hip fracture program for elders Geriatric Orthopaedic Surgery & Rehabilitation, 6-14. doi:10.1177/2151458510378105. Ortho Info. The American Academy of Orthopedic Surgeons (2009, April). Hip Fractures. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=A00392 Oldmeadow, L.B., Edwards, E.R., Kimmel, L.A., Kipen, E., Robertson, V.J. & Bailey, M.J. (2006). No rest for the wounded: Early ambulation after surgery accelerates recovery. ANZ J Surg., 76(7):607-11. Lamb, S.E., Oldham, J.A., Morse, R.E. & Evans, J.G. (2002). Neuromuscular stimulation of the quadriceps muscle after hip fracture: A randomized controlled trial. Arch Phys Med Rehabil., 83(8):1087-92. References Mosely, A.M., Sherrington, C., Lord, S.R., Barraclough, E., St. George, R.J.& Cameron, I.D. (2009). Mobility training after hip fracture: A randomized controlled trial. Age Ageing, 38(1):74-80. Sherrington, C., Lord, S.R.& Herbert, R.D. (2004). A randomized controlled trial of weight- bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Arch Phys Med Rehabil, 85(5):710-6. Bischoff-Ferrari, H.A., Dawson-Hughes, B., Platz, A., Orav, E.J., Stähelin, H.B., …Willett, W.C. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: A randomized controlled trial. Arch Intern Med, 170(9):813–820.
HIP FRACTURES: TREATMENT AND PREVENTION Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 203, or complete your test online at EliteLearning.com/Book 98. What are some conditions that can weaken bones and make them more susceptible to breaking? a. Osteoporosis. b. Cancer. c. Stress injuries. d. All of the above. 99. Which hip fracture occurs between the neck of the femur 103. Neuromuscular stimulation of the quadriceps should begin within ___________after surgery. a. Two weeks. b. One month. c. One week. d. Five days.
104. The patient’s perceived risk of falls should also be assessed - some patients are not as mobile as they could be, simply because they are ________. a. Afraid of falling. b. Not interested. c. Stressed. d. Not ready. 105. Fall prevention in a nursing home setting will also require the following things: a. Strength and balance training. b. Gait assessment. c. Medication screening and other illnesses that might in- crease the risk of a hip fracture. d. All of the above. 106. Strengthening the muscles at a _________ will create stresses on the bones. a. Slow, steady rate. b. Fast rate. c. Gym. d. None of these. 107. The physical therapist can assist in pain management in the following ways: a. Using ice. b. Encouraging regular ROM of the LE. c. Explaining relaxation techniques and using TENS. d. All of the above.
and the lesser trochanter? a. Intracapsular fracture.
b. Subtrochanteric fracture. c. Intertrochanteric fracture. d. Stress fracture. 100. A large number of patients with hip fractures are not considered surgical candidates.
a. True. b. False.
101. A hip replacement done with the _________approach will limit hip adduction, internal rotation, and hip flexion beyond 90 degrees.
a. Anterior. b. Posterior. c. Artificial. d. None of the above.
102. Each recommendation should be carefully considered; recommending _________ services than the patient needs may increase the risk of fall upon discharge.
a. Fewer. b. More. c. Just enough. d. Excessive.
Course Code: PTCA02HF
Page 148
Book Code: PTCA2624
EliteLearning.com/ Physical-Therapy
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