# EXERCISE MODALITIES AND OUTCOME MEASURES USED IN OLDER ADULTS AFTER HIP FRACTURE WITH OR WITHOUT SIGNS OF COGNITIVE IMPAIRMENT: A NATIONAL CROSS-SECTIONAL E-SURVEY OF 90 OUT OF 98 MUNICIPALITIES IN DENMARK

## TL;DR

This study surveyed Danish municipalities to understand how older adults with hip fractures, including those with cognitive issues, are rehabilitated after discharge.

## Contribution

The study provides insights into the rehabilitation practices and assessment tools used for older adults with hip fractures in Denmark, highlighting gaps in cognitive screening.

## Key findings

- Most municipalities offered exercise programs 1–2 times per week for 5–12 weeks.
- Functional exercises were more common for hip fracture patients without cognitive impairment.
- Performance-based tests like 30s-sit-to-stand and Timed Up&Go were widely used.

## Abstract

To investigate rehabilitation settings, exercise modalities, and assessments provided post-discharge to older adults with hip fracture with and without signs of cognitive impairment.

National cross-sectional e-survey.

Rehabilitation managers and development physiotherapists from all 98 Danish municipalities.

Information was collected on rehabilitation after discharge across four settings: 24-h-care, home-based care, outpatient-healthcare-centers, and nursing-home-facilities.

Ninety municipalities (92%) responded. About half used standardized screening tools to guide rehabilitation, but only 4% screened for cognitive impairment. Rehabilitation was typically delivered by physiotherapists 1–2 times/week, lasting 5–12 weeks, with 24-h-care and nursing-home facilities settings offering shorter but more frequent sessions. Common exercise modalities included strengthening, balance, and functional tasks, where these were more used in hip fracture than hip fracture with signs of cognitive impairment. Patient-Reported-Outcome-Measures (PROMs) were infrequently used; the Patient-Specific-Functional-Scale and Numerical-Rating-Scale were most often used. Cognitive PROMs were rarely applied, except the Montreal-Cognitive-Assessment at 24-h-care. Performance-based tests were more widely used, particularly the 30s-sit-to-stand and Timed Up&Go tests.

The survey had a high response rate. Few municipalities used cognitive screening tests and pain scales whereas performance-based testing was more predominant. The preferred exercise modality was functional exercise, used more often for patients with hip fracture than those with hip fracture and signs of cognitive impairment.

After hip fracture, patients need rehabilitation to regain their physical function. In Denmark, this mostly takes place in municipalities after hospital discharge, with the goal of returning to previous activity levels. However, little is known about the type and length of training, or which tests are used, especially for patients with memory difficulties. We asked all 98 municipalities in Denmark about their rehabilitation services for older adults with hip fracture, including those with signs of memory difficulties. Ninety municipalities responded. Most municipalities offered exercise programmes 1–2 times per week for 5–12 weeks, but programmes in nursing homes or 24-h settings were often shorter or more intensive. Physiotherapists mainly delivered the rehabilitation, and programmes often focused on strengthening, balance, and daily function. Tools to assess memory loss and patient-reported outcomes were rarely used, whereas physical performance tests like the sit-to-stand and walking tests were widely applied across all settings.