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已发表论文
基于证据的股骨颈骨折老年患者全髋关节置换术后康复锻炼方案：一项德尔菲研究
Authors Gao Y, Zhu Q, Zhan X , Zhong F, Zhu Y , Li W, Zhu X
Received 21 August 2025
Accepted for publication 17 December 2025
Published 24 December 2025 Volume 2025:20 Pages 2651—2669
DOI https://doi.org/10.2147/CIA.S562419
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Maddalena Illario
Yazhuo Gao,1 Qianyin Zhu,2 Xiaoyan Zhan,3 Fangfang Zhong,1 Yuhan Zhu,1 Wenjia Li,1 Xuehua Zhu1
1School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Audit Office, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang Province, People’s Republic of China
Correspondence: Xuehua Zhu, School of Nursing, Zhejiang Chinese Medical University, No. 548 Binwen Road, Puyan Street, Binjiang District, Hangzhou, Zhejiang Province, 310053, People’s Republic of China, Email Snow_zxh@163.com
Background: Femoral neck fractures (FNFs) represent a significant public health challenge in aging populations. Total hip arthroplasty (THA) has emerged as the preferred surgical management for active geriatric patients over 60 years old. However, standardized, evidence-based rehabilitation protocols specifically tailored to the Chinese healthcare context remain limited.
Purpose: This study aimed to develop and validate an expert consensus-based exercise program for geriatric Chinese patients with FNFs undergoing THA, addressing gaps in pre-operative preparation, post-operative care, and home-based rehabilitation continuity.
Patients and Methods: Using the Model for Evidence-Based Practice Change framework, we conducted a multi-phase study: (1) needs assessment through semi-structured interviews with 21 healthcare professionals; (2) systematic evidence synthesis from 16 high-quality sources; and (3) iterative refine the program through two-round Delphi consultation with 15 multidisciplinary experts from orthopedics, rehabilitation medicine, nursing, and management.
Results: The Delphi process demonstrated high expert engagement (response rates: 93.75% round 1, 100% round 2) and acceptable authority (Cr=0.917). Expert coordination improved across rounds, with Kendall’s W values increasing from 0.244– 0.287 (round 1) to 0.104– 0.371 (round 2) for different item levels, and coefficient of variation decreasing from 0.00– 0.64 to 0.00– 0.14. 11 items with CV> 0.25 were eliminated after round 1, reflecting initial variability in expert opinions. The iterative consensus process yielded a four-domain program structure: (1) in-hospital pre-operative rehabilitation, (2) in-hospital post-operative rehabilitation, (3) out-of-hospital home-based rehabilitation, and (4) follow-up care. The final program comprises 4 first-level items, 17 second-level items, and 63 third-level items with specific operational parameters including timing, frequency, intensity, and methods adapted to Chinese clinical practice patterns.
Conclusion: Through rigorous expert consensus methodology, this study developed a comprehensive, multi-level rehabilitation framework for geriatric FNFs patients undergoing THA in China, achieving acceptable agreement on program content and feasibility. As consensus-based findings, prospective validation is essential to establish clinical effectiveness and guide evidence-based implementation.
Keywords: geriatric rehabilitation, exercise program, evidence-based design, Delphi expert consensus method
1School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Audit Office, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang Province, People’s Republic of China
Correspondence: Xuehua Zhu, School of Nursing, Zhejiang Chinese Medical University, No. 548 Binwen Road, Puyan Street, Binjiang District, Hangzhou, Zhejiang Province, 310053, People’s Republic of China, Email Snow_zxh@163.com
Background: Femoral neck fractures (FNFs) represent a significant public health challenge in aging populations. Total hip arthroplasty (THA) has emerged as the preferred surgical management for active geriatric patients over 60 years old. However, standardized, evidence-based rehabilitation protocols specifically tailored to the Chinese healthcare context remain limited.
Purpose: This study aimed to develop and validate an expert consensus-based exercise program for geriatric Chinese patients with FNFs undergoing THA, addressing gaps in pre-operative preparation, post-operative care, and home-based rehabilitation continuity.
Patients and Methods: Using the Model for Evidence-Based Practice Change framework, we conducted a multi-phase study: (1) needs assessment through semi-structured interviews with 21 healthcare professionals; (2) systematic evidence synthesis from 16 high-quality sources; and (3) iterative refine the program through two-round Delphi consultation with 15 multidisciplinary experts from orthopedics, rehabilitation medicine, nursing, and management.
Results: The Delphi process demonstrated high expert engagement (response rates: 93.75% round 1, 100% round 2) and acceptable authority (Cr=0.917). Expert coordination improved across rounds, with Kendall’s W values increasing from 0.244– 0.287 (round 1) to 0.104– 0.371 (round 2) for different item levels, and coefficient of variation decreasing from 0.00– 0.64 to 0.00– 0.14. 11 items with CV> 0.25 were eliminated after round 1, reflecting initial variability in expert opinions. The iterative consensus process yielded a four-domain program structure: (1) in-hospital pre-operative rehabilitation, (2) in-hospital post-operative rehabilitation, (3) out-of-hospital home-based rehabilitation, and (4) follow-up care. The final program comprises 4 first-level items, 17 second-level items, and 63 third-level items with specific operational parameters including timing, frequency, intensity, and methods adapted to Chinese clinical practice patterns.
Conclusion: Through rigorous expert consensus methodology, this study developed a comprehensive, multi-level rehabilitation framework for geriatric FNFs patients undergoing THA in China, achieving acceptable agreement on program content and feasibility. As consensus-based findings, prospective validation is essential to establish clinical effectiveness and guide evidence-based implementation.
Keywords: geriatric rehabilitation, exercise program, evidence-based design, Delphi expert consensus method