Implementation and validation of a novel clinical bedside tool (Time-Up and Flex) in rehabilitation for geriatric hip fracture patients post hip fracture surgery

Abstract

Objective

Fragility fractures in the elderly population is increasing due to the global aging population. Rehabilitation following hip fracture surgery plays a crucial role in restoring functional independence and quality of life. There are currently limited bedside rehabilitation tool for geriatric hip fracture patients. A novel tool (Time-Up and Flex [TUF]) was designed with the aim to allow patients perform bedside rehab exercises, provide objective feedback and enhance recovery.

Design

A single centre, double-blinded, prospective validation study. A 3D printed TUF tool measures time taken to actively flex the operated hip to 30° on post-operative days [POD] 1, 7 and 14. The time is compared against subjective (Numerical Patient Reported Pain Scale [NPRS]) and objective outcomes (Tinetti Scale [TS], Functional Ambulation Category [FAC]). Assessors of the TUF score are blinded to the assessors of patient report outcome measures.

Results

Mean time for TUF were 12.7 s (seconds), 9.5 s and 6.7 s, NPRS were 7.3, 4.8, 3.2, TS were 9.8, 14.1, 18.6, FAC were 1.2, 2.0, 3.1 on POD1, 7 and 14 respectively. Coefficient of correlation for TUF time against NPRS was 0.729 (p < 0.05), TUF time against TS was -0.721 (p < 0.05), TUF time against FAC -0.688 (p < 0.05). A decrease in TUF time correlated to a statistically significant decrease in NPRS, increase in TS and FAC. The calculated Cohen's D and Cronbach Alpha for TUF tool supported its ability to produce consistent and valid results.

Conclusion

TUF tool is valid and correlates with patient's subjective and objective outcomes. It has a good predictor value for the patient's pain, mobility and future falls risk. TUF tool has potential to be incorporated into geriatric hip fracture rehabilitation pathway in the future.