Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study

Abstract

To determine the predictors of functional outcomes and quality of life (QoL) of patients who were surgically treated for fragility hip fracture. This was a retrospective cohort study performed in the 3 tertiary rehabilitation facilities. A total of 165 patients who had undergone surgery for fragility hip fracture were followed up to 6 months postoperatively. The factors expected to be related to the functional outcomes and QoL at 6 months post-surgery were as follows: baseline demographics, fracture site, operation type, fall characteristics including fall location and fall direction, comorbidities, and initial functional status. The following were comorbidities: hypertension, diabetes mellitus, dementia, cerebrovascular accident, and osteoporosis. Functional outcome and QoL measures were represented using the Koval grade, functional ambulatory category (FAC), Berg balance scale, 4-m walking speed test, the Korean version of Mini-Mental State Examination, EuroQol 5-dimension (EQ-5D) questionnaire, the Korean version of Modified Barthel Index, and the Korean version of instrumental activities of daily living (K-IADL). For all tests, each patient was assessed immediately after transfer and at 6 months post-surgery. Multivariable regression analyses adjusting for factors mentioned above were as follows. Old age led to a significantly less favorable outcome on FAC and K-IADL at 6 months. Intertrochanteric fracture had a significantly positive impact on Koval at 6 months compared to femur neck and intertrochanteric fractures. Total hip replacement arthroplasty and bipolar hemiarthroplasty had a significantly positive impact on EQ-5D and FAC at 6 months respectively compared to other operation types. Fall characteristics didn’t reveal any significant impact on functional outcomes and QoL. Patients with hypertension and diabetes mellitus had a significantly negative outcome on EQ-5D and K-IADL respectively. Among initial assessments of function and QoL, initial 4-m walking speed test, Korean version of Mini-Mental State Examination, K-IADL, and Korean version of Modified Barthel Index were independent predictors of function and QoL at 6 months. This study confirmed that age, fracture site, operation type, comorbidities, and initial physical and cognitive function significantly influenced recovery of function and QoL at 6 months in patients with fragility hip fractures.

Associated Factors of Functional Ability in Older Persons Undergoing Hip Surgery Immediately Post-Hospital Discharge: A Prospective Study

“…Comorbidity also did not predict functional ability two weeks post-hospital discharge. Our findings differ from prior studies [26,38,39], which have indicated that comorbidities affect functional recovery. Additionally, the findings of this study revealed that severe health conditions-those with an ASA classification of 3-4-did not predict good functional ability two weeks postdischarge when compared to the other classifications, which differ from the findings of previous studies [40].…”

“…This study's findings revealed that internal fixation procedures of the hip were a significant predictor of poor postoperative functional ability immediately after hospital discharge. These results are consistent with previous studies [26,29]. However, internal fixation requires a longer time for the bone to heal, meaning that it may be less likely for patients to regain normal functional ability when followed up at 12 months [15].…”

“…In terms of age, this study revealed that the majority of participants undergoing hip fracture surgery were classified as middle-old, with an average age of 78.10 years (SD = 8.37; range = 60-93 years), which is consistent with previous studies regarding the impact of aging on delayed recovery and poor functional ability after a hip surgery. A number of studies have revealed that older adults, particularly the middle-old group, experience a slight delay in functional recovery after hip surgery compared to those considered young-old [25][26][27]. Moreover, in this study, 47.5% of the participants who had hip fractures were aged 80 years or over, which is consistent with studies in the People's Republic of China, Taiwan, and Japan, where the incidence of hip fractures increased with increasing age, especially for those aged 55 years and older [1,14,28].…”

Benefits of a family-based care transition program for older adults after hip fracture surgery

“…Accordingly, HF has been so far acknowledged as one of the leading causes of disability and mortality in this age group, and its related costs have been a global economic burden. It is notable that fewer than 40–60% of HF survivors regain their pre-fracture mobility status [ 2 ]. Furthermore, this condition is closely associated with multiple deficiencies in activities of daily living (ADLs), which subsequently result in loss of independence and low self-esteem.…”