OASIS Alert

Published on Sun Nov 04, 2012 PDF

Your hip fracture patients are at risk.

If you're looking to boost your outcomes for improvement in ambulation/locomotion, you may want to look into a hidden factor causing slow and difficult recovery for hip fracture patients. A new study suggests these patients may benefit from psychological help.

Post traumatic stress disorder can create a sense of fear in elderly patients recovering from hip fractures. That's the conclusion of a new review article by Brown University researchers who found evidence linking post traumatic stress disorder (PTSD) to injuries caused by "high-velocity trauma, such as motor vehicle accidents and falls from height," according to physician Daniel Aaron with Brown's Department of Orthopedics.

Those aren't the only accidents to trigger the condition-affecting disorder, though. "Generally, higher-energy mechanisms are most commonly associated with PTSD, but no specific type of fracture or injury has been identified," Aaron noted in a release on the article published in the Journal of the American Academy of Orthopedics. "Basically, any type of musculoskeletal injury that results from significant trauma may be associated with PTSD."

Not uncommon: Twenty to 51 percent of people with an orthopedic injury develop PTSD, according to the release.

Risk factors: Female patients and those who use alcohol and drugs and have lower socioeconomic status and less education are at higher risk of developing PTSD, according to the release. So are younger people. "One study also suggests people of Hispanic origin may be at greater risk for PTSD," the release notes.

Symptoms: A person with PTSD "may have nightmares, hyper-arousal symptoms, difficulty concentrating, blunted affect due to emotional numbing," and they may refuse to think or talk about their trauma, Aaron tells Eli. "There are some studies that talk about people's pain coping ability corresponding to PTSD," he adds. "People at risk of developing PTSD often have higher self-reported pain."

Potential consequences: "Without effective treatment, PTSD can hinder activities of daily living, such as bathing, eating, paying bills, shopping, laundry and other household chores," Aaron said in the release. "Patients with PTSD also may be delayed in returning to work."

People with an acute form of post-traumatic stress, which has signs "more or less" like PTSD, are more likely to develop the chronic form, Aaron cautions. But psychological intervention can help prevent that from happening, he adds.

If you do identify acute or longer-term post-traumatic stress, consider referring the person to a behavioral health professional, such as a psychologist or psychiatrist, Aaron suggests. He points to a number of medications that have been studied for treating the condition, including "beta blockers and alpha-1 inhibitors such as prazosin, SSRIs, and benzodiazepines, among others."

Clinicians should also understand that a person with post-traumatic stress symptoms maybe be "a little bit slower to rehab physically, as well as psychologically," Aaron advises. "Being sensitive to that is important."

Researchers Zero In On Elderly Hip Fracture Patients

Researchers are now taking a closer look at this issue in elderly patients with hip fractures. This population may also have "an emotional and psychological component" related to their fractures, although it's not specifically post-traumatic stress, Aaron tells Eli. "While it hasn't been well studied," information in the literature suggests "that some elderly patients have [a fear of re-falling] after a hip fracture," he says. And the fear "inhibits their ability to participate in rehabilitation."

Therapists should consider rehab approaches tailored to the patient population. "Patients who have sustained a fracture often are fearful of falling because they have experienced many direct consequences" of a fall, such as surgery or immobilization, says PT Kate Brewer of Greenfield Rehabilitation Agency Inc. in Greenfield, Wis. In working with these patients, the physical therapist "should resist the urge to discount their verbalized fear, because it is very real to the patient."

Note: For more information on therapy, see Eli's Rehab Report at www.elihealthcare.com.