When do we start exercises after fractures...and what exercises?

[Quadrilateral0576]

Hi! I work as a Private Community Carer and our company wants us to spend time with our clients supervising them to do (rehab and/or physio)exercises. But we were left on our own as to the proper timing of starting the exercises AND what specific exercises to do for the service users. My questions are:

When can we start exercises for patient discharged home (s/p)status post (1)Fracture Neck Of Femur (2) s/p Total Hip Replacement (3) s/p TKR. Those three are the most common cases I see in the community. If there are other lower limb fractures with recommended start period as to when exercises can start then I would appreciate the added info very much.

What will be the recommended exercises for patient discharged home (s/p)status post (1)Fracture Neck Of Femur (2) s/p Total Hip Replacement (3) s/p TKR.

Is there a nice online article(link pls) dealing with my questions so I can do additional readings aside form the expert advice that I can get from here?

Thank you very much in advance!

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[Awhina]

Hello,
I can see your dilemma, but the solution is reasonably simple:
Exercises can start when the treating surgeon is giving the green light.
The type, duration, frequency and intensity of exercises is determined by the individual assessment. There are no standard exercises for any fracture or surgical procedure. And many indications and contraindications need to be checked.
Exercise prescription after such significant injuries should be prescribedby a trained professional, such as a physiotherapist. They will also advise on the home-based programme.
I am surprised that these clients do not already have a programme in place - will they not have been seen by a physio already (e.g. in hospital)?
Cheers,
Awhina

[Quadrilateral0576]

Thanks Awhina for the reply!

Exercises can start when the treating surgeon is giving the green light.

This is what I believe....that the captain is the doctor, specifically the ortho surgeon...and it is he/she who can say when physio can start..and it could vary from patient to patient AND from one type of fracture(or procedure) to another. But is there a general rule(s) as to when(4wks after or 6wks after or 8wks after) physiotherapy exercises can start?

Exercise prescription after such significant injuries should be prescribedby a trained professional, such as a physiotherapist.

Yes, I agree. Which is why I was just surprised when we(comm carer) were told to make sure our patients are not deconditioned at home and that they should be encouraged & supervised by us to do standard/generic bed exercises(ankle pumps, knee raises, heel slides, squeezing buttocks & pressing back of knees to bed).

I am surprised that these clients do not already have a programme in place - will they not have been seen by a physio already (e.g. in hospital)?

That's the proper discharge procedure I was expecting for these patients with fractures s/p POP application and/or procedures(TKR, THR etc)...but no..they are discharged with no initial physio assessment in the hospital ..and maybe just for home visit by a physio once they're home. I'd like to think it's a way of decongesting wards and/or beds.

[Awhina]

But is there a general rule(s) as to when(4wks after or 6wks after or 8wks after) physiotherapy exercises can start?

No

Another question please - Why does management expect clients to decondition at home? Are they discharged before they can walk?

Cheers,
Andrea