8.1 Introduction

Mobilisation is a critical component of supporting recovery and rehabilitation after fragility fracture. ‘Mobilisation’ usually refers to moving the injured limb or the act of mobility practice. Mobility practice includes moving from lying to sitting, sitting to standing and walking, with or without the aid of others or devices. Mobilisation and exercise after fragility fracture tend to denote structured activities that are practised and progressed to enable the body to regain movement to enable a return to function and prevent post-fracture complications.

The aim of this chapter is to promote the role of the nurse and other practitioners in patients’ early mobilisation and exercise after fragility fractures. The importance of early mobilisation and exercise is highlighted, along with practical information on easily applicable assessments, pain and weight bearing and tips on how to facilitate early mobilisation. There is a focus on early mobilisation after hip fracture as this is the most common significant fragility fracture requiring hospitalisation and surgery. However, many of the issues covered are in common with other types of fragility fracture.

In many healthcare settings, there may be specialist healthcare professionals in physical rehabilitation such as physiotherapists, occupational therapists or rehabilitation nurses. While these professionals can provide expertise in assessment and management of post-fragility fracture mobilisation and exercise, the whole care team have a role in supporting these activities to enable patients to reach independent mobility in the first place and their recovery goals in the longer term.

8.2 Learning Outcomes

At the end of the chapter, the reader will be able to:

  • Appreciate the problems of inactivity after fragility fracture.

  • Describe the rationale and evidence regarding the importance of early mobilisation after hip fracture surgery.

  • Discuss the trajectory, importance of monitoring and influence of fracture-related pain on mobility outcomes.

  • Rationalise and question commonly used restrictions after surgery for a fragility fracture.

  • Use easily applicable and valid outcome measures for evaluation of patients with a fragility fracture.

  • Employ strategies to facilitate early mobilisation and exercise after fragility fracture.

8.3 Immobilisation in Fracture Management

The earliest recorded use of immobilisation and rest for injured limbs was by the ancient Egyptians approximately 3000 years B.C. [1]. Ever since, there has been ongoing refinement and use of external splinting and movement restrictions to manage fractures [2, 3]. A wide range of effects of immobilisation have been studied in animal and human models (Table 8.1). What is evident is that the musculoskeletal system is responsive to mechanical loading, or stress [4] and absence or diminished mechanical loading below usual levels is detrimental to tissues as they enter a catabolic state or degradation. Mechanical loading is required for musculoskeletal tissue homeostasis and, if increased within physiological limits, is an anabolic, or biosynthesis, stimulus for bone healing [5, 6]. After a fracture, periods of immobilisation are clinically associated with joint stiffness and muscle weakness. As a result, there have been efforts to reduce periods of immobilisation and non-weight bearing after fracture as much as possible. For example, there have been several clinical trials assessing early weight bearing and movement after ankle fracture surgery [7, 8].

Table 8.1 Summary of the effects of immobilisation on bones and muscles from basic research [5, 9,10,11]
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8.4 Early Mobilisation After Fragility Fracture

In the context of fragility fracture management, it is vital to consider the impacts of immobility on wider body systems, not just the musculoskeletal issues after injury. After a hip fracture, longer periods of immobility are associated with serious complications, including respiratory infection, delirium, pressure injuries, thromboembolic events, worse recovery of function and increased risk of mortality [12,13,14].

The importance of early surgical treatment for hip fracture has been shown in a systematic review [15]. The rationale for early surgery is, in part, to enable early weight-bearing mobilisation to reduce the detrimental impacts of immobility. Contemporary surgery for hip fracture using internal fixation or arthroplasty should aim to enable early weight-bearing mobilisation. In fact, early mobilisation is now increasingly monitored in national hip fracture databases and is core to many clinical guidelines. For example, the United Kingdom’s National Institute for Health and Care Excellence clinical guidelines for hip fracture recommend ‘mobilisation on the day after surgery’ [16]. Early mobilisation is also a key recommendation in the Academy of Orthopaedic Physical Therapy Clinical Practice Guidelines [17].

Studies have used different time cut-offs for defining early mobilisation after hip fracture surgery, e.g. 24 or 36–48 h post-operatively. In practice, this means getting patients up and mobilising on the day of or day after surgery. In a recent large-scale observational research in the United Kingdom, early mobilisation after hip fracture has been found to be associated with increased probability of discharge from hospital [18] and increased survival and ambulatory recovery for patients (with and without dementia) at 30 days after surgery [13]. Correspondingly, in Danish and Irish hip fracture registry studies, early mobilisation has been associated with increased survival [19, 20]. Focusing on post-surgery ambulatory status as well as the status after day one also seem important and are associated with mortality, medical complications and discharge destination for patients admitted from their own home [21]. Two further studies from the Danish hip fracture registry have shown increased mortality, readmission and risk of infection in patients where the pre-fracture ambulatory status, evaluated with the Cumulated Ambulation Score (CAS) [22], did not recover at the time of acute hospital discharge [23, 24]. Thus, recovering baseline mobility as soon as possible has been highlighted as an important first-step recovery goal [25].

The CAS is an easily applicable score that was designed for patients with hip fracture (feasible for all fragility fractures) for the monitoring of basic mobility until independence has been reached. It evaluates three activities: getting in and out of bed, ‘sit to stand to sit’ from a chair with armrests and indoor walking with or without an assistive device. A 1-day CAS of 0–6 points is based on a score from 0 to 2 for each activity, where a score of 0 = not able to, 1 = able to with assistance/guiding and 2 = independent of human assistance [26]. The CAS is currently available in more than 15 languages and proven feasible in several patient groups, and further information is available here [27]. Using such a score to monitor mobility following fragility fracture is not only the domain of the physiotherapist but also a useful way to evaluate care for nurses and other health professionals.

Although early mobilisation is clearly a critical goal, and something that the whole care team is responsible for achieving, there are many complex challenges in achieving this. Common barriers to early mobilisation after hip fracture include hypotension, pain control issues, agitation or refusal [14], and cardiovascular instability [28]. These barriers are important to assess and actively attempt to prevent and manage (see Chaps. 7, 12,13 and 14).

8.5 Fragility Fracture-Related Pain and Other Factors Influencing Mobilisation

Having a hip fracture is extremely painful for those who experience this injury. The initial management often involves complete immobilisation until post-surgery. However, patients with other fragility fractures also experience fracture-related pain that can compromise their ambulatory status. For example, people who usually use walking aids can struggle to walk after sustaining a wrist or proximal humerus fracture. Still, patients with a hip fracture are probably the fragility fracture group that most often experience pain influencing their ability to mobilise (get up from a chair and walk) [29].

Effective pain management is crucial following a fragility fracture, enabling patients to ambulate and participate in the physical training and exercise programmes essential for their recovery (see also Chap. 7). An individualised approach to pain management is important. People have different experiences of pain and use of pain medication before their fracture, and varying pain trajectories are seen for different fracture types. A standard pain management program, where all patients are given the same pain medication, will be sufficient for some but overtreat some, and not be sufficient for others. Pain management needs to be guided by ongoing (several times daily) pain assessments by nurses, physiotherapists and other healthcare professions. A validated pain score is needed. All healthcare professions are familiar with the Visual Analogue Scale (VAS, 0–10 or 0–100 points) [30] and the Numeric Rating Scale (NRS, 0–10 points) [31] where patients are asked to, respectively, mark their pain on a ruler or report as a number (Table 8.2).

Table 8.2 Overview of common pain assessment scales
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The VAS and NRS pain scores are commonly used for many patient groups. Following hip fracture, and especially for those with dementia or other cognitive disorders, the VRS (0–4 points) is valid and superior to the VAS [32, 33]. The VRS 0–4-point scale evaluates pain in categories where:

0 = no pain

1 = slight pain

2 = moderate pain

3 = severe pain

4 = unbearable pain

Numbers are not presented to the patient; they are only used to record the result in care records. The VRS manual [34] states: ‘When using the VRS, it is important to ask about the degree of pain when using the categories and without using numbers’. Many patients find it difficult to express the degree of pain, so when using the VRS scale, a dialogue with the patient can be conducted. If the patient indicates unbearable pain, the practitioner can, for example, ask: ‘Is it as bad as when you just broke your hip’?

While pain can be assessed at rest, more importantly, it should be assessed during activity such as walking or sit to stand from a chair, to get a ‘true picture’ of how pain treatment is working. This is referred to as ‘dynamic pain’. Using the VRS for evaluating whether pain management is sufficient—none to mild pain (VRS 0–1) at rest and mild to moderate pain (VRS 1–2) during activity—is useful, especially in the early post-operative stage. At later time points, adjustment of pain management should be considered for moderate to unbearable pain (VRS 3–4) during activity. Correspondingly, for patients with acute vertebral fragility fractures, systematic monitoring of dynamic pain is also recommended, using a scale specifically for patients with dementia who are unable to verbalise their pain [35].

Fracture-related pain is not the same for different fracture types (Chap. 7). Patients with an intracapsular femoral fracture (surgical procedure; osteosynthesis or arthroplasty), for example, can experience less pain than those with extracapsular inter- and subtrochanteric fractures (surgical procedure; dynamic hip screw or intramedullary hip screw). This is the case both during the first post-operative days [36] and on discharge from hospital [37]. Intracapsular femoral fractures are also associated with better ambulatory status [38].

Patients often compare their progress with those around them, leading to disappointment if their recovery progress is not the same. They should be informed that this can be ‘normal’ and experiencing more pain does not mean that something is wrong but may simply be due to different fracture types. Other factors that can contribute to a slower recovery for patients with an extracapsular trochanteric fracture can be the larger blood loss/anaemia [39,40,41] and the markedly greater quadriceps strength loss compared to patients with an intracapsular femoral fracture [42]. Hip fracture-related pain can also influence the walking distance for the 6-min walking test [43].

Other factors that influence the acute care ambulatory status are the age and pre-fracture functional level of the patient. Pre-fracture functional level evaluated with the modified [44] New Mobility Score (NMS) [45] is a strong predictor of the basic mobility CAS level in the acute setting [46,47,48] and for mortality in the long term [45, 49]. The NMS, 0–9 points, evaluates three activities: indoor walking, outdoor walking and walking during shopping. Each activity is scored by asking patients or relatives/carers how well these activities are managed, with a score of 0 = not at all, 1 = with help from another person, 2 = with a walking aid and 3 = no difficulty and no aid (the instrument is available here) [44, 50].

This is important information to give to patients and their relatives worrying about a slower than expected recovery. Practitioners should also consider these factors in their practice, enabling them to identify when ongoing pain assessment and management are most needed, as well as the interference of pain (among other variables) in patient mobility. Close collaboration within the rehab team regarding pain assessments and management is also important [25]. It is vital to coordinate periods of more intense mobility and physical training with pain medication doses and to liaise with the prescribing practitioner if medication seems insufficient during mobility or is a barrier to movement. Fracture-related pain and fatigue are the most restricting factors for patients with hip fracture being able to ambulate independently and participate in the planned physiotherapy, during the early post-operative period [29].

8.6 Surgical Procedure and Mobilisation After Lower Limb Fragility Fracture

Different countries have different approaches to movement and weight-bearing restrictions following fragility fracture surgery. The tendency is that restrictions have been reduced over the years and are now rare in some parts of the world. Still, for patients having a hemi- or total hip arthroplasty after a cervical femoral fracture, some hip precautions may be stipulated in post-surgical protocols to reduce the risk of luxation (dislocation of the joint). If the conventional posterior surgical approach to the hip is used for the procedure, then common restrictions are:

  1. 1.

    No hip flexion >90°

  2. 2.

    No hip adduction over the midline

  3. 3.

    No internal rotation of the hip (no crossing of legs) during the first few months post-surgery

However, the ‘muscle-sparing’ approach (SPAIRE) for hemiarthroplasty is more commonly used. This seems to reduce luxation when compared to the conventional posterior approach, and improved function and reduced mortality have been reported [51, 52]. The SPAIRE technique is considered safe and may facilitate return to pre-injury level of mobility [53]. If the anterior or lateral approach is used for surgery, then fewer restrictions are typically applied [54].

It is essential that patients are informed that hip precautions do not mean that they are not allowed to walk, exercise and perform daily life activities, just that these precautions need to be considered while doing this. Aids and adaptations may be needed to achieve hip precautions (e.g. seat risers, sock aids) to support independence. Depending on the country, an occupational therapist or a nurse may be involved in selecting aids and managing restrictions.

Weight-bearing protocols after lower limb fragility fractures also differ globally, from no restrictions (weight bearing as tolerated on the fractured leg) to partial or no weight bearing at all for different time periods. In some countries, almost 100% of older patients with hip fracture are allowed weight bearing as tolerated immediately, as prescribed by the surgeon (no waiting for post-surgery X-rays). This is in line with findings of a large UK and Ireland audit including about 20,000 patients with a hip fracture [55]; 96% were allowed unrestricted weight bearing immediately after surgery. However, for non-hip fragility fractures, only 32% were allowed unrestricted weight bearing, illustrating that this may be handled differently for different fragility fracture groups [55].

Although nurses and physiotherapists do not usually make decisions or changes regarding movement and weight-bearing restrictions, they might discuss the necessity of reviewing such restrictions with the lead clinician if practice is based on tradition rather than evidence. The importance of reviewing routine weight-bearing restrictions for people with hip fracture was highlighted in a Spanish cohort study—a few weeks of non-weight bearing was associated with reduced function [56] and increased mortality [57] at 1 year.

Patients with acetabular fractures [58] and hip fractures [59] may be unable to follow weight-bearing restrictions. Kammerlander et al. [59] concluded:

‘Elderly patients seem to be unable to maintain weight-bearing restrictions. As early mobilization of geriatric trauma patients is an important element for a successful rehabilitation, the directive of postoperative partial weight-bearing for these patients should be abandoned’.

8.7 Practical Suggestions for Facilitating Early Mobilisation

After a fragility fracture, encouraging mobility is critical for a sustained recovery and bone healing, keeping joints mobile, maintaining and strengthening muscles, optimising motor control and returning to functional activities. The following offer suggestions for facilitating this.

  • Patient handling: Safe patient handling, correct body mechanics, familiarity with organisation/facility policy, and equipment and training requirements regarding the mobility of patients are just a few of the many important safety considerations for all team members at all times.

  • Assessment: A patient assessment is required to determine how many staff members are needed and what manual handling equipment will be needed for mobilisation. This should include their history, physical function and laboratory/diagnostic study findings for abnormalities (such as signs of infection and cardiovascular status) and the patient’s weight, current and pre-fracture mobility, cognitive function and medical treatments.

  • Coordination: Coordination is needed with other team members if assistance is anticipated and to acquire assistive transfer devices if necessary.

  • Falls: A patient with a lower extremity fracture is at higher risk of falling again (Chap. 4), so additional support on the affected side may be necessary when mobilising.

  • Independence: The most important aspect of mobilisation is for patients to accomplish as much as they can on their own and for staff to provide as little support as possible to improve independence as quickly as is feasible. Evaluation and analysis of the functional ability and level of dependence of older individuals in self-care found that staff frequently did tasks that older people were capable of performing, increasing their levels of dependence. Developing practices that support and sustain autonomy is recommended [60]. When dealing with a patient who lacks the ability to care for themselves, practitioners should guide, assist physically, foster an atmosphere conducive to improvement and promote learning [61].

  • Orthostatic hypotension: If the patient moves from lying or sitting to standing too quickly, a significant drop in blood pressure can occur. Before helping a patient stand or walk, check their vital signs, blood pressure, mental status and any other symptoms they may be experiencing, such as dizziness and pain. Raising the head of the bed to a high-fowler’s position, helping the patient rise from the bed by slowly sitting them up, moving to the side of the bed and bringing their legs over the edge can help to prevent this.

  • Transfers: Once the patient’s respiratory rate, heart rate and blood pressure have stabilised, equipment for manually transferring patients can be used [62] such as transfer belts, transfer boards, standing hoists and pivot discs. Some healthcare organisations only permit manual transfer when the patient’s life is in danger or when the assisting personnel do not need to carry most or all of the patient’s weight [63].

  • Injury prevention: Knowing the local policy regulating patient mobility and remembering that practitioners are at a higher risk for work-related neck, shoulder and back injuries, while performing manual patient transfers [64].

There are numerous ways in which practitioners can enhance patient mobility.

  • Sit to stand: Practitioners can facilitate patients’ access to mobility practice opportunities as part of their care. One example is helping/encouraging patients to eat while sitting in a chair rather than staying in bed during mealtimes, so they will frequently practise the sit-to-stand movement. The ability to rise from a seated to a standing position is necessary for the initiation of walking and other functional activities. Given the significance of being able to stand up from a seated posture, the sit-to-stand activity is as a pertinent, inexpensive and usually successful intervention to enhance or preserve mobility in older adults. While there is some evidence that sit-to-stand activity improves the outcomes of older people, additional research is required [65]. Given the low cost of such sit-to-stand interventions, research of its implementation in low- and middle-income nations might be especially beneficial.

  • Walking: While adhering to any weight-bearing or other restrictions, patients should be encouraged to use walking aids (see below) at appropriate times throughout the day, such as when they need to use the bathroom. When discussing the post-operative care plan with patients, practitioners can also support achieving recovery through increasing/improving their daily walking distance (using visual landmarks that the patient could relate to or a specific mobility goal such as 900 steps/day).

8.7.1 Selecting Walking Aids

Practitioners supporting patients in using walking aids need to ensure that guidelines for effective and safe practice are considered, for example, ensuring that medical issues in the post-operative period such as acute cardiovascular instability do not contraindicate mobilisation.

The appropriate walking aid for a patient depends on a variety of factors, including the patient’s specific needs, physical capabilities and weight-bearing indication. The patient’s strength, endurance, balance, cognitive function and needs of the environment should all be taken into account when deciding the walking aid. To prescribe and train patients in walking aids, health professionals need appropriate training to achieve local competencies or standards.

The following provides guidance to support patients with walking aid, and links to videos are offered with each section to provide the reader with a more visual overview. If you are uncertain or have any doubts regarding the safety of patients’ mobility capacity and the appropriate assistive device, please confer with specialist healthcare professionals in physical rehabilitation such as physiotherapists, occupational therapists or rehabilitation nurses before encouraging and assisting patients on using walking aids.

The basic principles in walking aid selection are that walking sticks and crutches are less supportive and require more balance and coordination than, e.g., a standard four-legged walker. Therefore, in the early post-operative phase, it is common for people with hip fracture to start mobilising by using walking frames of various types. If they are unable to stand up, specialist manual handling equipment is often used to help the patient transfer from bed to chair. Walking frames, crutches and canes are examples of walking aids that can be used to help patients to gain stability, mobility and independence. Those with lower limb weakness or poor balance can benefit from walking frames to provide additional stability and mobility as this enables some weight to be supported through the upper limbs, as well as provides a wider base of support (see Table 8.3).

Table 8.3 How to support use of a walker/walking frames on a flat surface
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Crutches can help patients who need to use their upper limbs to support weight bearing and propulsion but require greater coordination and balance (see Table 8.4). The three major purposes of a cane/walking stick are to shift body weight away from a painful or weakened lower limb, to raise the centre of gravity and to increase sensory information about the surroundings, all of which contribute to greater balance [66].

Table 8.4 How to use crutches for climbing stairs
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Nursing care programmes emphasising basic self-care can be helpful in improving functional outcomes among older patients hospitalised [67].

A crucial measure involves engaging and motivating the family/caregivers (Chap. 15) to involve patients in mobility practice. A useful resource to support family and caregivers is available here [68]. There are interprofessional standards regarding the safe patient handling and mobility [69], but family carers should also be taught how to assist patients in moving from lying to sitting, sitting to standing and using walking aids* (based on any weight-bearing restrictions) according to the equipment and the environment they will have available at home. As patient-handling equipment and devices become more widely available for use in the home, carers must be provided with opportunity to learn how to utilise them safely [70].

When designing a care plan for a patient, it is important to take into account the patient’s knowledge, cultural values and ethnic beliefs accompanying the loss of independence, evaluate their knowledge and provide information about the consequences of immobility. This may be enough for the patient to cooperate with mobilisation practices following surgery [62].

8.8 Early Exercise After Hip Fracture

In addition to mobility training and weight-bearing activity, a wide range of exercises are used to support recovery after hip fracture. A systematic review and meta-analysis of exercise interventions targeting physical function that were commenced in the first 3 months after hip fracture [71] found nine randomised controlled trials, recruiting 669 participants. There was high to moderate quality evidence that exercise interventions improve physical function, but the evidence for the optimal mode of exercise was uncertain. Hulsbæk et al. [72] examined the evidence regarding the effects of exercise for people following hip fracture in their systematic review and meta-analysis. Although the evidence had some uncertainties, across 49 studies involving 3905 participants, they found that exercise had:

  • Small-to-moderate positive effects in the short term (end of intervention) on mobility, activities of daily living, lower limb muscle strength and balance

  • Small-to-moderate positive effects at long term (closest outcome data to 1 year post-fracture) on mobility, balance and health-related quality of life

The 2022 Cochrane review [73] of interventions for improving mobility after hip fracture surgery in adults highlighted the complexity in assessing the evidence for exercise after hip fracture. There are multiple types of exercise that can be used, including but not limited to:

  • Gait training

  • Balance and functional training

  • Resistance/strength training

  • Endurance exercises

  • Flexibility exercises

Exercise programmes also have different doses, levels of health professional supervision and variable settings (e.g. in-hospital, clinics, home-based). Although there are some uncertainties in the evidence to date, the available evidence demonstrates that exercise is a critical component of rehabilitation across the recovery journey, from very early in-hospital rehabilitation through to later community-based rehabilitation. Indeed, structured exercises including progressive high-intensity resistance strength, balance, weight bearing and functional mobility training have been recommended in national clinical guidelines from the Academy of Orthopaedic Physical Therapy and the Academy of Geriatric Physical Therapy of the American Physical Therapy Association [17].

A major challenge in rehabilitation is ensuring that exercise programmes are performed accurately and at a frequency that will achieve their desired affect (e.g. improved muscle strength) [74]. While exercise programmes are commonly prescribed by physiotherapists for individual patients, the whole care team has a key role in supporting patients with regular training. Strategies to facilitate exercise programme adherence may include reminders and prompts to perform prescribed exercises, assessing and addressing barriers to exercise such as pain, and providing feedback on performance.

8.9 Nutrition, Mobilisation and Exercise After Hip Fracture

While there has been a focus on mobilisation and exercise for people after hip fracture in this chapter, it is important to highlight that, for the benefits of exercise to be realised, a focus on optimising nutrition is required. It is common for older adults to be malnourished at the time of injury and to experience reduced food intake [75]. Again, highlighting the multi-disciplinarity of hip fracture rehabilitation, nutritional status and needs are often assessed and managed by nursing staff and specialist dieticians (Chap. 11). Whether facilitating food intake or through use of nutritional supplements, supporting sufficient calorie intake is important for exercise and mobilisation practice, and to ensure enough protein to build muscle bulk. There is also a role for carers in this aspect of recovery (see Chap. 15), and a useful guide has been produced by the Royal College of Physicians in the United Kingdom accessible here [76].

Summary of the Main Points

  • After a hip fracture, short and longer periods of immobility are associated with serious complications, including respiratory infection, delirium, pressure sores, thromboembolic events, worse recovery of function and increased risk of mortality.

  • Early mobilisation and continued after day one should be a key focus after a fragility fracture and now increasingly monitored in national hip fracture databases, which is a core part of many clinical guidelines.

  • Nurses should recognise the factors that impact patient’s early mobility, such as the pre-fracture function and the type of hip fracture and pain, and identify the main scales used to assess patients and how to manage these issues.

  • Although movement and weight-bearing restrictions are not something that nurses or physiotherapists decide on or change, they might discuss the necessity of reviewing such restrictions with the responsible lead clinical staff/surgeons, if based on tradition rather than evidence.

  • Safe patient handling, correct body mechanics and familiarity with facility policy regarding the mobility of patients are just a few of the many important safety considerations that all healthcare team members must consider at all times.

  • Assess patient history and laboratory/diagnostic study findings for abnormalities and the patient’s weight, mobility, cognitive function and medical treatments to determine how many staff members will be needed for mobilisation.

  • Before helping a patient stand or walk, check their vital signs, blood pressure, cognitive status and any other symptoms they may be experiencing, such as dizziness and pain.

  • The everyday duties of nurses can be modified so that patients can engage in mobility-enhancing practice: for instance, assisting/encouraging patients to eat out of bed during mealtimes, instructing them on the use of walking aids at various times of the day and negotiating an increase/improvement in the daily ward walking distance.

8.10 Suggested Further Study

Use this chapter to help you determine your team’s educational needs in terms of early mobilisation and exercise after fragility fracture and consider how these needs might be addressed. Examples of educational resources include:

Health Safe Executive. Moving and handling in health and social care. https://www.hse.gov.uk/healthservices/moving-handling.htm

NHS inform. Using crutches. https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/walking-aids/using-crutches

NHS inform. Using a walking frame https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/walking-aids/using-a-walking-frame

Royal College of Nursing. Moving and handling. https://www.rcn.org.uk/Get-Help/RCN-advice/moving-and-handling

The National Institute for Occupational Safety and Health. Safe Patient Handling and Mobility. https://www.cdc.gov/niosh/topics/safepatient/default.html

8.11 How to Self-Assess Learning

After reading this chapter and undertaking additional study, you can evaluate the following choices for deciding what you have learned and how it applies to your practice and team:

  • Share what you have learned from this chapter with your colleagues, and discuss ways your team could improve early mobilisation practice and exercise for fragility fracture patients.

  • Perform regular searches to explore the most recent recommendations about early mobilisation practices and exercise for fragility fracture patients.

  • Meet with specialists and other team members to discuss and disseminate the most recent findings.

  • Obtain guidance from skilled clinicians, and gain knowledge from experts in the field.