Early prediction of gait ability in patients with hip fracture

Abstract

Objective Many elderly patients with hip fracture (HF) present with gait deficits. As such, an HF both indirectly and directly increases the number of elderly people requiring care, making it a major medical and economic problem in an aging society. To facilitate the treatment of HF and attempt to resolve the consequences, we have attempted to derive an equation that would predict gait ability. The prediction equation was developed by multivariate analysis using standard evaluation methods, with inclusion of guaranteed objectivity where possible. We attached greater importance to the prediction of gait ability early in the period of hospitalization, since this allows for early determination of an efficient therapeutic strategy. Methods The subjects were 54 HF patients (six men, 48 women; mean age: 78.0 ± 8.4 years) admitted to general hospitals in Hirosaki, Aomori prefecture, between 1998 and 2007. All were aged 60 years or older and were able to walk immediately before injury; physical therapy was initiated for all individuals during hospitalization. Evaluation items related to physical function, psychological function, and complications that may affect gait were evaluated; these included the manual muscle test, motor age test, Katz's index, dementia (HDS-R), consciousness disturbance, among others.Results Based on data for 35 patients who could gait at discharge and 19 patients who could not, a model including MAT, HDS-R, and the New York Heart Association classification of cardiac function scores (P \ 0.001) was obtained using multiple logistic regression analysis (discriminant hitting ratio: 94.4%). Conclusions The effectiveness of the derived model suggests that both physical and psychological functions should be considered for gait prediction.

Who Will Walk Again? Effects of Rehabilitation on the Ambulatory Status in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture

“…This was reflected in the mobility scores measured, supporting the opinion that short intensive rehabilitation allows the patients to be restored to prefracture mobility levels better than leaving these patients without any ward-based program or having an extended program that incurs high socioeconomic costs. Similar to previous findings, 2 , 7 the short-term supervised exercises likely improved mobility outcomes of the elderly patients through the targeted approach of a formal program. It is also known that ward-based programs for an extended period breed dependence through the prolonged lack of an environment that promotes functional independence, explaining the poorer results seen in the mobility outcomes of the extended program.…”

“…It has been established that rehabilitation improves ambulatory outcomes, confidence in avoiding subsequent falls, and health-related quality of life and reduces caregiver burden. 2 , 6 , 7 However, rehabilitation ranges from subacute ward-based programs to home-based programs. Cultural and social factors have also influenced the use of rehabilitation facilities beyond what was initially intended.…”

“…18,19 Previous studies have shown that muscle strength, Katz Index, in-hospital complications, and discharge destinations affect gait ability and quality in one way or another. 7,8 Perioperative strategies to improve outcomes have been optimized through multidisciplinary orthogeriatric teams. Postoperative measures in improving ambulatory outcomes consist of outpatient rehabilitation, intensive short inpatient rehabilitation, and extended slow-stream inpatient rehabilitation.…”