Phases of Post-Operative Rehabilitation
Phases of post-operative rehabilitation are identified by the stages of healing of soft tissue and bone
- overlapping phases of tissue healing (inflammation, proliferation, remodeling)
- level of difficulty of activities (initial, intermediate, advanced)
- degree of protection of healing tissues (maximum, moderate, minimum)
Fractures in elderly patient have longer healing phases. The elderly population is at higher risk for infection and hospital-acquired infection (nosocomial)
Degrees of Protection
|
Maximum Protection Acute healing stage |
Inflammatory stage/acute Vigilant protection of tissues May include immobilization May include low-level stresses (e.g., partial, assisted or passive ROM) Isometric exercise to prevent excessive atrophy Physical agents for pain management and tissue healing Ranges from 3-7 days Procallus formation, developing bone callus |
|
Moderate Protection Subacute healing stage |
Subacute/proliferative phase Pain and tenderness is minimal Increased stresses to bone and soft tissue are indicated to restore function Exercises to restore normal kinematics, strength, function Neuromuscular exercises to increase efficiency, coordination and control of movement Physical agents for pain management and muscle re-education Ranges from 4-6 weeks to 8-12 weeks Bone callus formation into hard callus |
|
Minimal Protection Return to Function healing stage |
Begins when full to almost full, pain-free ROM is available Joint mobility is restored and stable Focus is on task-specific, functional activities for the individual patient and prevention of secondary complications ( e.g., fall prevention, endurance) Ranges from 6-12 weeks to 6 months Bony remodeling to eliminate callus and restore bone strength |
