Effects of Individualized Physical Therapy and Group Physical Therapy on Functional Outcomes in Patients With Femoral Neck Fracture in Gaza Strip

Femoral neck fractures are a significant public health concern, particularly among the elderly population. According to Dyer the incidence of hip fractures is rising, leading to a marked decline in physical function and increased morbidity and mortality rates . For patients experiencing hip fractures, key outcomes such as survivability, morbidity, and functional independence in activities of daily living (ADLs) are profoundly impacted. Hip fractures abruptly alter a person's life and may increase their reliance on others to carry out everyday tasks. Femoral neck fractures have a significant negative impact on quality of life by creating mobility issues. After being hospitalized for a hip fracture, only roughly 60% of patients are able to walk normally again. A growing percentage of people who survive neck of fracture injuries go on to suffer from varying degrees of later handicap, such as the development of excruciating osteoarthritis in their hip joints, a high risk of falls, and additional hip fracture injuries. Furthermore, Fractured individuals experience lower quality of life due to poor balance and movement, as well as reduced functional and social independence. This suggests that many people never resume their pre-fracture way of life. While much of the existing research has focused on the physical aspects of recovery, such as restoring pre-fracture functional abilities, less attention has been given to the psychological factors that influence functional mobility. Successful recovery is not solely dependent on physical rehabilitation but also on psychological well-being. Psychological comorbidities are significantly associated with both mortality and functional outcome in patients with neck of femur fractures. More than half of all patients reported continued sleep disturbance 3 months post orthopaedic operation. Early identification and management of sleep disturbances can improve functional and emotional recovery outcomes. Fatigue from poor sleep may hinder adherence to home exercise regimens, impacting overall recovery . Also, patients with a femoral neck fracture are at an increased risk of subsequent major depression. Interestingly, patients undergoing surgery for femoral neck fracture with comorbid psychological problems are at increased risk for non-routine discharge. These problems are independently associated with an increased risk for post-operative complications. An awareness of these risks should optimize preoperative multidisciplinary patient care planning so as to maximize patient outcome. In patients with a hip fracture, post-operative rehabilitation can enhance clinical results and quality of life. Prolonged immobilization can lead to functional decline and complications like falls and pressure ulcers. Early mobilization helps prevent these issues. A systematic review conducted by Peeters, et al found that home-based rehabilitation programs incorporating strength exercises significantly improved health status components. Additionally, stone et al. found that a more intensive community-based multimodal therapy (six or more in-person sessions per week) did not lead to better outcomes at three months compared to a less frequent regimen (three or fewer sessions per week). Group-based rehabilitation strategies have also been shown to enhance functional outcomes. Coulter found that group Physical Therapy following joint replacement surgery yielded functional recovery results comparable to customized home-based physical therapy. Similarly, Tarakci demonstrated that supervised group exercise training significantly improved balance and functional status in patients with multiple sclerosis, further reinforcing the effectiveness of group-based interventions. On the other hand, O'Keeffe compared the efficacy of individual and group Physical Therapy exercise programs for musculoskeletal problems. Their findings revealed no clinically significant differences between the two approaches in terms of pain and impairment outcome. Previous research suggests that group engagement during rehabilitation can enhance motivation and improve recovery outcomes. In contrast, individualized rehabilitation may provide more focused care but could lack the psychological and social benefits associated with group-based therapy. So, it is not clear whether exercises performed in a group or individualized settings are better for improving outcomes post femoral neck fractures. There is a gap in the literature regarding the impact of rehabilitation environments (group and individualized setting) on functional mobility and ADL independence in patients recovering from femoral neck fractures. To our knowledge, a few studies have examined the influence of Physical Therapy interventions on functional and psychological factors in this population. Thus, this study aims to bridge this gap by exploring the effect of different rehabilitation settings on functional mobility, ADL independence, sleep and psychological factors in patients recovering from femoral neck fractures. Statement of The Problem Despite the profound effects of femoral neck fractures on both physical and mental health, there is a notable lack of comprehensive rehabilitation protocols tailored to address the multifaceted needs of these patients. Current rehabilitation practices often focus primarily on physical recovery, neglecting the critical psychological and sleep-related aspects that are essential for holistic recovery. Femoral neck fractures often lead to a decline in physical function, resulting in increased dependence on caregivers and a reduced ability to perform activities of daily living (ADLs). Furthermore, the aftermath of femoral neck fractures is frequently accompanied by sleep disturbances, which can exacerbate fatigue and hinder recovery. The psychological ramifications are equally concerning, as many patients experience heightened levels of depression and anxiety following their injury, further complicating their rehabilitation process Study objectives General objective: To compare the effects of individualized Physical Therapy and group Physical Therapy on functional outcomes in patients with femoral neck fractures in Gaza strip. Specific Objectives: To evaluate the effects of individualized Physical Therapy Program on functional independence in the ADLs, sleep quality, depression and anxiety in patients with femoral neck fractures in Gaza strip. To evaluate the effects of group Physical Therapy Program on functional independence in the ADLs, sleep quality, depression and anxiety in patients with femoral neck fractures in Gaza Strip. Hypothesis H0 There will be no significant difference in functional independence in ADLs between patients recovering from femoral neck fractures who undergo rehabilitation in individualized Physical Therapy and group Physical Therapy. H1 There will be a significant difference in functional independence in ADLs between patients recovering from femoral neck fractures who undergo rehabilitation in individualized Physical Therapy and group Physical Therapy. There will be a significant difference in sleep quality between patients recovering from femoral neck fractures who undergo rehabilitation in individualized Physical Therapy and group Physical Therapy. There will be a significant difference in depression and anxiety symptoms between patients recovering from femoral neck fractures who undergo rehabilitation in individualized Physical Therapy and group Physical Therapy. 1.7 Research Questions Is there a significant difference in functional independence in ADLs between patients recovering from femoral neck fractures who undergo rehabilitation in individualized Physical Therapy and group Physical Therapy? Is there a significant difference in sleep quality between patients recovering from femoral neck fractures who undergo rehabilitation in individualized Physical Therapy and group Physical Therapy? Is there a significant difference in depression and anxiety symptoms between patients recovering from femoral neck fractures who undergo rehabilitation in individualized physical therapy and group physical therapy? What are the baseline levels of functional independence in ADLs, depression, anxiety, functional mobility, and sleep quality among patients with femoral neck fractures screened for the study? 1.5 Theoretical and Operational Definition of Terms Femoral neck fractures occur in the femoral neck, which is where the femoral head and shaft meet. Because of its placement, the femoral neck is prone to fracture, and in cases where it is displaced, disruption of the femoral head's blood supply is a major issue. Group physical therapy is a rehabilitation technique in which a professional physical therapist supervises therapeutic exercises or activities for two or more patients at the same time with the purpose of safely and effectively addressing individual or shared goals Individualized Physical Therapy is a rehabilitation technique in which a professional physical therapist supervises therapeutic exercises or activities for only one patient