This 2021 clinical practice guideline from the Academy of Orthopaedic Physical Therapy and Academy of Geriatric Physical Therapy grades evidence for physical therapy management of adults ≥65 with low-energy proximal femur fractures. It covers the full episode of care: acute inpatient, postacute skilled nursing, home, and community settings. Recommendations address examination, interprofessional management, and intervention across all phases.
Hip fracture carries a 32.5% one-year mortality in men and 21.9% in women — numbers most surgical trainees underestimate. The excess mortality is not evenly distributed: it is 6-fold higher in the first 6 months and essentially normalized by 12 months, and it is driven substantially by underlying frailty rather than the fracture itself.
This guideline is the evidence base for why day-1 assisted transfer and daily inpatient PT are standards, not optional add-ons. When you fix a hip fracture, weight bearing as tolerated is supported as early as possible. Restrictions are rarely indicated. Order daily PT from postoperative day 1.
Knee extensor strength drops >50% on the fractured side within 2 weeks. This deficit will not resolve on its own: when deficits in strength, balance, or function persist at 8–16 weeks, extended structured exercise is a strong (must) recommendation. Build this threshold into your discharge planning and follow-up.
Do not default to reduced rehabilitation for patients with mild-to-moderate dementia. The guideline explicitly states they should receive the same interventions and prescriptions as cognitively intact patients.
This 2021 clinical practice guideline from the Academy of Orthopaedic Physical Therapy and Academy of Geriatric Physical Therapy grades evidence for physical therapy management of adults ≥65 with low-energy proximal femur fractures. It covers the full episode of care: acute inpatient, postacute skilled nursing, home, and community settings. Recommendations address examination, interprofessional management, and intervention across all phases.
Hip fracture carries a 32.5% one-year mortality in men and 21.9% in women — numbers most surgical trainees underestimate. The excess mortality is not evenly distributed: it is 6-fold higher in the first 6 months and essentially normalized by 12 months, and it is driven substantially by underlying frailty rather than the fracture itself.
This guideline is the evidence base for why day-1 assisted transfer and daily inpatient PT are standards, not optional add-ons. When you fix a hip fracture, weight bearing as tolerated is supported as early as possible. Restrictions are rarely indicated. Order daily PT from postoperative day 1.
Knee extensor strength drops >50% on the fractured side within 2 weeks. This deficit will not resolve on its own: when deficits in strength, balance, or function persist at 8–16 weeks, extended structured exercise is a strong (must) recommendation. Build this threshold into your discharge planning and follow-up.
Do not default to reduced rehabilitation for patients with mild-to-moderate dementia. The guideline explicitly states they should receive the same interventions and prescriptions as cognitively intact patients.