REGAINing movement
Dr. Lauren Beaupre wants to help improve patient recovery after hip fracture.
Story by Tara Narwani/Photo by Veer
As people get older, the prospect of breaking a hip becomes a growing concern. According to Dr. Lauren Beaupre, "We have an aging population. In Edmonton, we see about 700 to 800 hip fractures every year."
The concern surrounding hip fractures is certainly justified; Dr. Beaupre describes it as a devastating injury. Hip fracture is painful, almost always requires surgery, and represents a difficult recovery for patients.
A key area of Dr. Beaupre's research is examining the outcomes of elderly patients (those aged 65 and older) who have broken their hips. She is particularly interested in those who live in continuing care facilities or nursing homes. Since more than 65% of these individuals have some cognitive impairment, they are often excluded from research studies. "Rehabilitation needs have not been closely examined in this group," says Dr. Beaupre, "and these people can't advocate for themselves."
One alarming result from Dr. Beaupre's work is that patients in continuing care from the Edmonton region show a steep decline in health after hip fracture. Whereas 71% of individuals living in the community returned to their level of movement and function prior to their injury, less than a quarter of continuing care residents did.
Certainly, hip fracture patients in continuing care experience a dramatic decrease in their quality of life. At the same time, the resources required to care for these people increases substantially. "If you have somebody who goes from being able to manage independently in their room—going to the bathroom or getting in and out of bed—to somebody who's no longer ambulatory, there's a much higher level of care required for that resident," explains Dr. Beaupre.
The current reality for hip fracture patients in continuing care represents a real opportunity to make things better, according to Dr. Beaupre. In early 2008, she launched the first study in a series called REGAIN (Recovery in Geriatric Ambulatory Patients Residing in Nursing Homes). The goal of the work is to look more closely at this group of patients and ask questions like, "Is rehabilitation research possible with these individuals, what is their baseline function, and how much rehabilitation are they exposed to in continuing care facilities?"
One issue appears to be the lack of rehabilitation resources in some facilities. In a hospital setting, even on the first day after hip surgery, patients are typically assisted to take a few steps. By day two, short walks are encouraged. In other words, early mobilization is a high priority. However, once these patients are transferred to continuing care, generally three to five days after surgery, lack of staff training or facility resources may stop the push for mobility.
"You can't take a frail 85-year-old person and sit them in a wheelchair for six weeks with no exercise and think that they'll ever walk again. They don't have great muscle mass to begin with," says Dr. Beaupre. Exercise builds up muscle mass, and muscles that are not used lose mass and become weaker.
To get at the question of whether rehabilitation can actually improve outcomes for patients recovering from hip fracture in continuing care, Dr. Beaupre will initiate the REGAIN II study in fall 2010. An outreach program involving physical therapists, occupational therapists, and their assistants will circulate through continuing care facilities in the Edmonton area to provide rehabilitation to patients for eight to ten weeks after their injury. The goal of the program is to get and keep patients walking while their hips heal. To assess the effects of the program, Dr. Beaupre and her team will monitor the patients' ability to walk independently, the distance they can walk, their ability to get in and out of a bed or a chair, and their ability to dress themselves. She hopes to see an improvement in that magic number: the percentage of people who regain the function that they had before the hip fracture.
Success for REGAIN II will have public policy implications. If a rehabilitation outreach program improves the quality of life for continuing care patients, there will be recommendations to support these types of initiatives in the future, and not just in Edmonton. "We're all realizing that, in an aging world, continuing care and hip fractures are going to be an issue," says Dr. Beaupre.