Quality standard
Quality statement 6: Rehabilitation after surgery
Quality statement 6: Rehabilitation after surgery
Quality statement
Adults with hip fracture start rehabilitation at least once a day, no later than the day after surgery. [2012, updated 2016]
Rationale
Early restoration of mobility after hip fracture surgery can be beneficial for the person because it can reduce the length of hospital stay and avoid the complications of prolonged bed confinement. Rehabilitation at least once a day has potential benefits of improved mobility, increased independence, and reduced need for institutional care. A physiotherapist assessment is needed before the rehabilitation starts. People should be offered support with rehabilitation every day while in hospital, which can be given by members of the multidisciplinary team when the physiotherapist is not present. This support should continue after discharge from hospital.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with hip fracture start rehabilitation at least once a day, no later than the day after surgery.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from service specifications and clinical protocols.
Process
a) Proportion of hip fracture operations after which the person starts rehabilitation no later than the day after surgery.
Numerator – the number in the denominator after which the person starts rehabilitation no later than the day after surgery.
Denominator – the number of hip fracture operations.
Data source: The National Hip Fracture Database (NHFD) records if the patient was mobilised on the day after surgery.
b) Proportion of hip fracture operations after which the person has rehabilitation at least once a day.
Numerator – the number in the denominator after which the person has rehabilitation at least once a day.
Denominator – the number of hip fracture operations.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, patient records.
Outcome
a) Length of hospital stay for people with hip fracture.
Data source: The NHFD records average length of stay.
b) Return to the pre-hip fracture place of residence.
Data source: The NHFD records whether patients were discharged back to their original residence or were in that residence at the routine follow-up (at 120 days).
c) Return to the pre-hip fracture level of mobility.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, patient records. The NHFD records the routine follow-up of hip fracture patients (at 120 days).
What the quality statement means for different audiences
Service providers (such as hospitals) ensure that systems are in place for people with hip fracture to start rehabilitation at least once a day, no later than the day after surgery.
Healthcare professionals (such as physiotherapists and nurses) offer rehabilitation at least once a day to people with hip fracture, starting no later than the day after surgery.
Commissioners (such as integrated care systems) ensure that they commission services in which people with hip fracture start rehabilitation at least once a day, no later than the day after surgery.
People who have had an operation for hip fracture are offered rehabilitation at least once a day to help them recover. Rehabilitation should be started by the day after their operation (unless there is a medical or surgical reason not to). Rehabilitation after a hip fracture operation includes support with sitting and standing and keeping an upright posture to improve movement and strength, and help with their recovery.
Source guidance
Hip fracture: management. NICE guideline CG124 (2011, updated 2023), recommendations 1.7.1 and 1.7.2
Definitions of terms used in this quality statement
Rehabilitation
Rehabilitation is the process of re-establishing the ability to move between postures (for example, from sitting to standing), maintain an upright posture and to ambulate with increasing levels of complexity (speed, changes of direction, dual and multi-tasking). [Adapted from NICE's full guideline on hip fracture and expert opinion]