Back to the Future: Getting a FReSH Start after hip fracture

Back to the Future: Getting a FReSH Start after hip fracture

Slips, trips and broken hips are all too common in people over age 65. For those older adults who experience a hip fracture, recovering from the trauma of the fall, the hip fracture surgery and the hospital stay may pose some challenges. For example, leaving the care of the health care team behind, and going “back to the future”, to resume usual activities at home. For some, simple daily activities like getting up from a chair, climbing stairs, or even walking, can seem insurmountable.

You, after a fall

Although people recover at different rates after breaking a hip, there are some common mobility (or walking) milestones frequently encountered. For example, immediately after the trauma of the fall and fracture there is always at least a temporary, or sometimes permanent decline in mobility. To minimize the effects of this reduced mobility, it is critical that older adults stay on track with their activity goals during recovery.

3 Keys to Successful Recovery

Keys to a successful recovery after hip fracture include

1)   Seeking advice and support during the recovery process

2)   Staying mobile

3)   Setting and working on realistic goals

What our research shows
Our recently published pilot trial aimed to help people do just that. In our study, we recruited 30 community dwelling older adults with hip fracture. Within the first few days of surgery, we provided all study participants with a personalized bedside teaching session using a patient centered educational manual and videos, the Fracture Recovery for Seniors at Home, FReSH START.

A personal connection

In addition, we randomized study participants, and half of the group received up to five coaching telephone calls over the first four months of recovery. During the phone calls, a research physiotherapist coached participants to continue, and progress daily prescribed exercises, as well as reminders to stay active, and problem solve issues that could interfere with mobility and recovery (e.g., pain or fatigue). Participants were encouraged to ask questions about the timeline of their recovery, set and achieve their own personal health and mobility goals, and to stay active doing everyday “functional” activities, such standing up from a chair, or gradually increasing their walking distance. The physiotherapist coached participants to continue to do their prescribed exercises, and directed them to existing community resources, such as falls prevention classes.

At the end of the study, we interviewed the older adults and the clinical team about their perceptions of the manual, and asked for suggestions for the content of the education and telephone calls. The health care team provided valuable feedback that we added back into the manual. Older adults told us that are often overwhelmed by the traumatic event of hip fracture, and found it difficult to retain and process information and education, particularly in the hospital environment. We will use this information to improve the way we deliver education and support older adults in the future, as they transition home after hip fracture.

What if I want a copy of the FReSH Start manual?

The FReSH Start Manual is available for free to people all over the world in English, Punjabi and Chinese. Our goal is to help people in recovery and their caregivers get the best care possible following a hip fracture.

FReSH Start Toolkit available in:

  • English
  • Chinese
  • Farsi
  • French
  • Korean
  • Punjabi


  1. Young Y, Xiong K, Pruzek RM, Brant LJ. Examining heterogeneity of functional recovery among older adults with hip fractures. J Am Med Dir Assoc. 2010;11(2):132-9.
  2. Schiller C, Franke T, Belle J, Sims-Gould J, Sale J, Ashe MC. Words of wisdom - patient perspectives to guide recovery for older adults after hip fracture: a qualitative study. Patient Prefer Adherence. 2015;9:57-64.
  3. Langford DP FL, Brown KC, Cho NJ, Frost M, Ledoyen M, Lehn J, Panagiotopoulos K, Sharpe N, Ashe MC. Back to the future- feasibility of recruitment and retention to patient education and telephone follow up after hip fracture: a pilot randomized controlled trial. Patient Preference and Adherence. 2015;9:1343-51.