Influencing factors of early weight-bearing exercise after hip fracture surgery in the elderly from the perspective of medical staff: a qualitative study_West China Medical Journal

Authors：

YANG Juan ^1,2 ,  LU Qunfeng ^1,2,3 , JI Jianlin ³ , YANG Liling ^1,3 , DONG Meiling ¹ , ZHAI Dahong ¹ , ZHANG Na ¹ , MO Minling ¹

1. Department of Nursing, Shanghai Sixth People’s Hospital, Shanghai 200233, P. R. China;
2. Tongji University School of Medicine, Shanghai 200092, P. R. China;
3. Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China;

Corresponding?author：

LU Qunfeng, Email: luluroom2004@163.com

Keywords：

Elderly; hip fracture; early weight-bearing exercise; theory of planned behavior; influencing factor

DOI：

10.7507/1002-0179.202606297

Video：

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Objective To explore the influencing factors of early weight-bearing exercise after hip fracture surgery in the elderly from the perspective of medical staff. Methods Based on the theory of planned behavior, a descriptive qualitative research method was adopted. Orthopedic surgeons, rehabilitation therapists and nurses directly involved in relevant work at Shanghai Sixth People’s Hospital were selected for interviews from October to December 2025. The influencing factors of postoperative early weight-bearing exercise in elderly hip fracture patients were inquired, and directed content analysis was used for data sorting and analysis. Results A total of 26 medical staff were interviewed. The analysis revealed that the facilitating factors for early weight-bearing exercise in elderly patients after hip fracture surgery included behavioral attitude (medical staff’s recognition of the rehabilitation and professional value of early weight-bearing), subjective norm (multidisciplinary collaboration and promotion by administrators), and perceived behavioral control (intelligent devices and information support improving self-efficacy). The barriers consisted of behavioral attitude (fear of risks and pressure from institutional environment), subjective norm (negative social pressure from patients and their families, and hierarchical dependence among medical staff), and perceived behavioral control (insufficient human resources, lack of objective assessment tools, and equipment deficiencies). Conclusions Early weight-bearing exercise after hip fracture surgery in the elderly is constrained by multidimensional factors. Intervention strategies should be developed from the dimensions of attitude reconstruction, norm reshaping and control empowerment to narrow the knowledge-practice gap between evidence-based guidelines and clinical practice, so as to effectively facilitate the clinical implementation of early weight-bearing exercise.

Citation： YANG Juan, LU Qunfeng, JI Jianlin, YANG Liling, DONG Meiling, ZHAI Dahong, ZHANG Na, MO Minling. Influencing factors of early weight-bearing exercise after hip fracture surgery in the elderly from the perspective of medical staff: a qualitative study. West China Medical Journal, 2026, 41(9): 1453-1459. doi: 10.7507/1002-0179.202606297 Copy

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2.	高峰, 段鑫, 劉佳鑫, 等. 老年髖部骨折患者手術時機及運動鍛煉綜述[J]. 華西醫學, 2020, 35(10): 1263-1266.
3.	Bai F, Leng M, Zhang Y, et al. Effectiveness of intensive versus regular or no exercise in older adults after hip fracture surgery: a systematic review and meta-analysis[J]. Braz J Phys Ther, 2023, 27(1): 100482.
4.	Sarkies MN, Testa L, Carrigan A, et al. Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis[J]. Age Ageing, 2023, 52(8): afad154.
5.	Li N, Cheng KY, Zhang J, et al. Immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post hoc analysis[J]. BMC Musculoskelet Disord, 2024, 25(1): 1041.
6.	Xu S, Gao F, Chen Y, et al. Impact of postoperative weight-bearing protocols on prognosis in geriatric hip fracture patients: a systematic review and meta-analysis[J]. J Clin Med, 2026, 15(10): 3912.
7.	Min K, Beom J, Kim BR, et al. Clinical practice guideline for postoperative rehabilitation in older patients with hip fractures[J]. Ann Rehabil Med, 2021, 45: 225-259.
8.	Griffiths R, Babu S, Dixon P, et al. Guideline for the management of hip fractures 2020[J]. Anaesthesia, 2021, 76: 225-237.
9.	O’Connor MI, Switzer JA. AAOS clinical practice guideline summary: management of hip fractures in older adults[J]. J Am Acad Orthop Surg, 2022, 30(20): e1291-e1296.
10.	中華醫學會骨科學分會創傷骨科學組, 中華醫學會骨科學分會外固定與肢體重建學組. 中國下肢骨折術后負重專家共識(2023)[J]. 中華創傷骨科雜志, 2023, 25(2): 93-100.
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12.	Turabi RY, O’Connell MDL, Wyatt D, et al. Weight-bearing and mobilisation timing after hip fracture surgery in older adults: an international survey of clinicians’ perspectives[J]. Eur Geriatr Med, 2025, 16(3): 909-920.
13.	Zhang J, Yang M, Zhang X, et al. The effectiveness of a co-management care model on older hip fracture patients in China: a multicentre non-randomised controlled study[J]. Lancet Reg Health West Pac, 2022, 19: 100348.
14.	Turabi RY, Wyatt D, Guerra S, et al. Barriers and facilitators of weight bearing after hip fracture surgery among older adults: a scoping review[J]. Osteoporos Int, 2023, 34: 1193-1205.
15.	賴婷, 吳明瓏, 胡凱利, 等. 全髖關節置換術后患者運動恐懼軌跡的潛在類別及影響因素分析[J]. 華西醫學, 2024, 39(10): 1571-1578.
16.	Fu Y, Zhu LJ, Li DC, et al. Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture[J]. World J Clin Cases, 2022, 10(10): 3069-3077.
17.	Tarrant SM, Attia J, Balogh ZJ. The influence of weight-bearing status on post-operative mobility and outcomes in geriatric hip fracture[J]. Eur J Trauma Emerg Surg, 2022, 48(5): 4093-4103.
18.	Turabi RY, Sheehan KJ, Guerra S, et al. Barriers and facilitators to early mobilisation and weight-bearing as tolerated after hip fracture surgery among older adults in Saudi Arabia: a qualitative study[J]. Age Ageing, 2024, 53(4): afae075.
19.	王芳, 楊富國. 以計劃行為理論為指導的康復干預方案在全髖關節置換術患者中的應用效果[J]. 醫藥前沿, 2024, 14(31): 106-108, 112.
20.	朱敬熹. 計劃行為理論(TPB)研究綜述[J]. 體育科技文獻通報, 2020, 28(4): 185-188.
21.	Ajzen I. The theory of planned behavior[J]. Organ Behav Hum Decis Process, 1991, 50: 179-211.
22.	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9): 1277-1288.
23.	Zhao WJ, Walasek L, Bhatia S. Psychological mechanisms of loss aversion: a drift-diffusion decomposition[J]. Cogn Psychol, 2020, 123: 101331.
24.	王東, 周君琳. 老年髖部骨折術后早期負重的時機及其影響因素[J]. 中華老年骨科與康復電子雜志, 2017, 3(5): 257-259.
25.	劉艷翠, 劉宇, 沈琴, 等. 醫護人員視角下危重癥患兒早期活動影響因素的質性研究[J]. 中華護理雜志, 2026, 61(4): 536-542.
26.	Ajzen I. Attitudes, personality, and behavior[M]. Maidenhead: Open University Press, 2005.
27.	國家衛生健康委辦公廳. 國家衛生健康委辦公廳關于進一步加強醫療質量(安全)不良事件管理的通知[R]. 北京: 國家衛生健康委辦公廳, 2024.
28.	中華人民共和國最高人民法院. 最高法: 善盡診療義務、符合診療規范的行為依法免責[R]. 北京: 中華人民共和國最高人民法院, 2026.
29.	National Institute for Health and Care Excellence. Hip fracture: management[R]. London: National Institute for Health and Care Excellence, 2023.
30.	黃天雯, 李娜, 肖萬蓮, 等. 專科護士主導的護理干預對高齡髖部骨折患者的影響[J]. 護理學雜志, 2023, 38(9): 45-48.
31.	陸美嬌. 專科護士主導多學科協作康復管理模式在老年髖部骨折早期康復中的應用研究[D]. 百色: 右江民族醫學院, 2023.
32.	Meehan AJ, Maher AB, Brent L, et al. The International Collaboration of Orthopaedic Nursing (ICON): best practice nursing care standards for older adults with fragility hip fracture[J]. Int J Orthop Trauma Nurs, 2019, 32: 3-26.
33.	楊娟, 陸群峰, 翟大紅, 等. 智能干預在老年髖部骨折患者術后負重鍛煉中的應用進展[J]. 中華現代護理雜志, 2025, 31(31): 4212-4218.
34.	Liu X, Huang C, Lin L, et al. Visualized load-bearing-based robot control system improves early function in femoral neck fracture patients: a randomized controlled trial focusing on outcomes after total hip arthroplasty[J]. J Orthop Surg Res, 2025, 20(1): 673.
35.	Latif A, Al Janabi HF, Joshi M, et al. Use of commercially available wearable devices for physical rehabilitation in healthcare: a systematic review[J]. BMJ Open, 2024, 14(11): e084086.
36.	Ding S, Chen Y, Huang C, et al. Perception and response of skeleton to mechanical stress[J]. Phys Life Rev, 2024, 49: 77-94.

1. 李寧, 李新萍, 楊明輝, 等. 老年髖部骨折的骨質疏松癥診療專家共識[J]. 中華骨與關節外科雜志, 2021, 14(8): 657-663.
2. 高峰, 段鑫, 劉佳鑫, 等. 老年髖部骨折患者手術時機及運動鍛煉綜述[J]. 華西醫學, 2020, 35(10): 1263-1266.
3. Bai F, Leng M, Zhang Y, et al. Effectiveness of intensive versus regular or no exercise in older adults after hip fracture surgery: a systematic review and meta-analysis[J]. Braz J Phys Ther, 2023, 27(1): 100482.
4. Sarkies MN, Testa L, Carrigan A, et al. Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis[J]. Age Ageing, 2023, 52(8): afad154.
5. Li N, Cheng KY, Zhang J, et al. Immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post hoc analysis[J]. BMC Musculoskelet Disord, 2024, 25(1): 1041.
6. Xu S, Gao F, Chen Y, et al. Impact of postoperative weight-bearing protocols on prognosis in geriatric hip fracture patients: a systematic review and meta-analysis[J]. J Clin Med, 2026, 15(10): 3912.
7. Min K, Beom J, Kim BR, et al. Clinical practice guideline for postoperative rehabilitation in older patients with hip fractures[J]. Ann Rehabil Med, 2021, 45: 225-259.
8. Griffiths R, Babu S, Dixon P, et al. Guideline for the management of hip fractures 2020[J]. Anaesthesia, 2021, 76: 225-237.
9. O’Connor MI, Switzer JA. AAOS clinical practice guideline summary: management of hip fractures in older adults[J]. J Am Acad Orthop Surg, 2022, 30(20): e1291-e1296.
10. 中華醫學會骨科學分會創傷骨科學組, 中華醫學會骨科學分會外固定與肢體重建學組. 中國下肢骨折術后負重專家共識(2023)[J]. 中華創傷骨科雜志, 2023, 25(2): 93-100.
11. 中華人民共和國國家衛生健康委員會醫政司. 老年髖部骨折診療與管理指南(2022 年版)[J]. 中華創傷骨科雜志, 2023, 25(4): 277-283.
12. Turabi RY, O’Connell MDL, Wyatt D, et al. Weight-bearing and mobilisation timing after hip fracture surgery in older adults: an international survey of clinicians’ perspectives[J]. Eur Geriatr Med, 2025, 16(3): 909-920.
13. Zhang J, Yang M, Zhang X, et al. The effectiveness of a co-management care model on older hip fracture patients in China: a multicentre non-randomised controlled study[J]. Lancet Reg Health West Pac, 2022, 19: 100348.
14. Turabi RY, Wyatt D, Guerra S, et al. Barriers and facilitators of weight bearing after hip fracture surgery among older adults: a scoping review[J]. Osteoporos Int, 2023, 34: 1193-1205.
15. 賴婷, 吳明瓏, 胡凱利, 等. 全髖關節置換術后患者運動恐懼軌跡的潛在類別及影響因素分析[J]. 華西醫學, 2024, 39(10): 1571-1578.
16. Fu Y, Zhu LJ, Li DC, et al. Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture[J]. World J Clin Cases, 2022, 10(10): 3069-3077.
17. Tarrant SM, Attia J, Balogh ZJ. The influence of weight-bearing status on post-operative mobility and outcomes in geriatric hip fracture[J]. Eur J Trauma Emerg Surg, 2022, 48(5): 4093-4103.
18. Turabi RY, Sheehan KJ, Guerra S, et al. Barriers and facilitators to early mobilisation and weight-bearing as tolerated after hip fracture surgery among older adults in Saudi Arabia: a qualitative study[J]. Age Ageing, 2024, 53(4): afae075.
19. 王芳, 楊富國. 以計劃行為理論為指導的康復干預方案在全髖關節置換術患者中的應用效果[J]. 醫藥前沿, 2024, 14(31): 106-108, 112.
20. 朱敬熹. 計劃行為理論(TPB)研究綜述[J]. 體育科技文獻通報, 2020, 28(4): 185-188.
21. Ajzen I. The theory of planned behavior[J]. Organ Behav Hum Decis Process, 1991, 50: 179-211.
22. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9): 1277-1288.
23. Zhao WJ, Walasek L, Bhatia S. Psychological mechanisms of loss aversion: a drift-diffusion decomposition[J]. Cogn Psychol, 2020, 123: 101331.
24. 王東, 周君琳. 老年髖部骨折術后早期負重的時機及其影響因素[J]. 中華老年骨科與康復電子雜志, 2017, 3(5): 257-259.
25. 劉艷翠, 劉宇, 沈琴, 等. 醫護人員視角下危重癥患兒早期活動影響因素的質性研究[J]. 中華護理雜志, 2026, 61(4): 536-542.
26. Ajzen I. Attitudes, personality, and behavior[M]. Maidenhead: Open University Press, 2005.
27. 國家衛生健康委辦公廳. 國家衛生健康委辦公廳關于進一步加強醫療質量(安全)不良事件管理的通知[R]. 北京: 國家衛生健康委辦公廳, 2024.
28. 中華人民共和國最高人民法院. 最高法: 善盡診療義務、符合診療規范的行為依法免責[R]. 北京: 中華人民共和國最高人民法院, 2026.
29. National Institute for Health and Care Excellence. Hip fracture: management[R]. London: National Institute for Health and Care Excellence, 2023.
30. 黃天雯, 李娜, 肖萬蓮, 等. 專科護士主導的護理干預對高齡髖部骨折患者的影響[J]. 護理學雜志, 2023, 38(9): 45-48.
31. 陸美嬌. 專科護士主導多學科協作康復管理模式在老年髖部骨折早期康復中的應用研究[D]. 百色: 右江民族醫學院, 2023.
32. Meehan AJ, Maher AB, Brent L, et al. The International Collaboration of Orthopaedic Nursing (ICON): best practice nursing care standards for older adults with fragility hip fracture[J]. Int J Orthop Trauma Nurs, 2019, 32: 3-26.
33. 楊娟, 陸群峰, 翟大紅, 等. 智能干預在老年髖部骨折患者術后負重鍛煉中的應用進展[J]. 中華現代護理雜志, 2025, 31(31): 4212-4218.
34. Liu X, Huang C, Lin L, et al. Visualized load-bearing-based robot control system improves early function in femoral neck fracture patients: a randomized controlled trial focusing on outcomes after total hip arthroplasty[J]. J Orthop Surg Res, 2025, 20(1): 673.
35. Latif A, Al Janabi HF, Joshi M, et al. Use of commercially available wearable devices for physical rehabilitation in healthcare: a systematic review[J]. BMJ Open, 2024, 14(11): e084086.
36. Ding S, Chen Y, Huang C, et al. Perception and response of skeleton to mechanical stress[J]. Phys Life Rev, 2024, 49: 77-94.

West China Medical Journal

Influencing factors of early weight-bearing exercise after hip fracture surgery in the elderly from the perspective of medical staff: a qualitative study

Abstract Full text Figures/Tables Video References Cited by

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