Interventions Used by Physical Therapists in Home Care for People After Hip Fracture

Background and Purpose: The majority of older people who survive a hip fracture have residual mobility disabilities. Any attempt to systematically reduce mobility disabilities after hip fracture, however, requires knowledge of the adequacy of current management practices. Therefore, the purpose of this study was to begin to understand the nature of physical therapy home care management by describing “usual care” for people after hip fracture. Subjects and Methods: In 2003 and 2004, a national survey was conducted of all members of the American Physical Therapy Association who identified home care as their primary practice setting (n=3,130). “Usual care” was operationally defined as when more than 50% of respondents reported that they “always” or “often” use a specific intervention. Results: Survey questionnaires (1,029) were returned with a response rate of 32.9%. Functional training activities, including bed mobility, transfer and gait training, balance training, safety training, and patient education, were reported very frequently. Active-range-of-motion exercises were performed much more frequently than exercises involving added resistance. Discussion and Conclusion: This study provides a detailed description of the physical therapy interventions provided in the home care setting for patients after hip fracture. The sample size and national representation increase our confidence that this description accurately depicts physical therapist practice.