Postcode Lottery in Physiotherapy After Hip Fracture Surgery 

Nicky Broyd

November 09, 2018

Hip fracture is the most common cause of injury related death in adults.

Now the Chartered Society of Physiotherapy (CSP) has published hip fracture rehabilitation standards after uncovering a 'wide variation' in the quality of care many patients receive across England and Wales.

Postcode Lottery

In 2017 the CSP commissioned a major audit (the Hip Sprint audit) of hip fracture rehabilitation provision involving more than 130 Trusts and over 7000 patients. 

It found wide variations in the extent, quality, and duration of hip-fracture rehabilitation and a 'postcode lottery' of care with some patients receiving less than an hour of physiotherapy a week and others waiting an average of 15 days before starting physiotherapy at home. 

It also found only 1 in 5 health services successfully maintained the continuity of their patients' rehabilitation following their operation and 1 in 10 community services received no handover information at all about hip fracture patients.

New Standards

The recommendations of the audit have resulted in the creation of the new standards, 'Hip fracture rehabilitation in physiotherapy practice: From hospital to home', which also link to existing quality standards and guidelines relevant to the rehabilitation of patients with hip fracture.

The new best practice standards from the CSP state that:

  • A physiotherapist should assess all patients on the day of, or day following, hip fracture surgery and put a rehabilitation care plan in place

  • All patients should be mobilised on the day of, or day following, hip fracture surgery. Any healthcare worker may perform this task but a physiotherapist should review any patient who does not mobilise within 24 hours

  • All patients should receive daily physiotherapy that totals at least 2 hours in the first week after hip fracture surgery, followed by at least 2 hours weekly until they have reached their goals

  • All patients moving from hospital should know the name of the team taking over the next phase of their rehabilitation and be seen by their new rehabilitation provider within 72 hours

  • A physiotherapist must be part of every hospital's Hip Fracture Governance programme, which should have responsibility for all stages of the care pathway

  • Physiotherapists should share their assessment findings and rehabilitation plans with all rehabilitation providers to enable clear communication with the MDT

Alex Mackenzie, CSP council chair, said in a press statement: "Rehabilitation must start from day one following surgery and continue without a wait, until a person is ready to leave hospital, and is able to resume normal activities. It is vital we give people the best opportunity to regain their mobility and above all, their independence."

The report says the standards are neither a maximum nor a minimum absolute level: "Many services in the audit already reached or exceeded these standards. Many services have work to undertake to improve the rehabilitation they offer."


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