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Clinical Rehabilitation, Vol. 21, No. 1, 36-40 (2007)
DOI: 10.1177/0269215506069243

Assertive rehabilitation for intracapsular fracture of the proximal femur

Suguru Ohsawa

Department of Rehabilitation Medicine, Osaka Rosai Hospital, Osaka

Aiko Miura

Mino Tanaka Hospital, Tokushima, Japan

Mie Yagyu

Anzu Oizumi

Eiji Yamada

Kamo Tanaka Hospital, Tokushima, Japan

Objective: To study the impact of assertive conservative therapy on walking in frail elderly patients with intracapsular fracture of the proximal femaur.

Design: Prospective non-randomized controlled trial.

Setting: Two private geriatric rehabilitation hospitals.

Subjects: From October 1997 to December 2004, 20 patients, not indicated for surgery, were treated with conservative therapy. There were 18 women and 2 men, and their ages were 87.1±4.2 (mean ±SD) years. All of them could walk before hip fracture.

Interventions: Thirteen patients accepted our assertive therapy, which consisted of standing on the fractured limb and walking in parallel bars as soon as possible. Seven patients refused our methods and were conventionally treated; the injured limb was immobilized under skin traction, and then they gradually tried to use a wheelchair for pain reduction.

Main measures: We used the following measures before therapy and six months after: Merle d'Aubigné & Postel's Hip Score, Functional Independence Measure (FIM) and face pain scale.

Results: The two groups were similar demographically. All patients except one (n = 12) responded to our method and could walk. However, the patients treated with the conventional method (n = 7) did not recover the ability to walk. The mean FIM (transfer and locomotion, five items) was 18.2 ±7.9 points in the former and 9.4 ± 4.3 points in the latter.

Conclusion: Assertive rehabilitation was more effective at restoring the ambulatory ability of frail elderly patients with intracapsular fracture of the hip than the conventional method.


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