Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool

Abstract

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.

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

“…There have been relatively many studies on mortality and ambulatory function after surgery according to fracture type. [24,[29][30][31][32][33][34][35][36] There was a study that showed no difference in mortality or function according to fracture type, [36] and there were rare reports that intertrochanteric fracture had worse Table 2 The evaluation of physical and cognitive function and quality of life immediately after transfer and at 6 months post-surgery (N = 165). function, [29,35] but overall, intertrochanteric fracture reported worse initial function, [24,30] mortality, [31,32] and functional outcomes.…”

Clinical Score for Predicting the Risk of Poor Ambulation at Discharge in Fragility Femoral Neck Fracture Patients: A Development Study

“…Moreover, most hospitals in Thailand do not perform MSE screening in their routine outpatient and inpatient practice. Finally, these scoring systems do not include some well-known predictive factors that serve as significant barriers to post-operative rehabilitation (e.g., concomitant fracture, post-operative ICU admission or ventilator use, and post-operative complication) [ 14 , 15 , 16 , 17 , 18 , 19 ]. Surgical techniques might be another promising prognostic factor that could have good predictive ability and should be incorporated into clinical scoring systems.…”

“…In contrast, individualized risk scoring systems have continuously emerged as a more attractive and more specific method that can improve predictive performance [ 17 , 18 , 19 ]. A few scoring systems have been developed for the prediction of post-operative functional outcomes and functional statuses, such as the simple scoring system by Hagino T. et al [ 17 ], the six risk scores by Burgos E. et al [ 23 ], the prognostic model for predicting the recovery of walking independence of elderly patients after hip-fracture surgery by Bellelli G. et al [ 41 ], and the predictive model of gait recovery at one month after hip fracture [ 16 ]. Table 5 provides specific details of the study domain, predictors used, and the definition of the clinical endpoint for each scoring system.…”

“…To date, only a few clinical scores for predicting in-hospital ambulation status among geriatric hip fracture patients are available, and often they are not specific for each subtype of hip fracture, resulting in low predictive performance [ 13 ]. Moreover, some of the previous scores did not include factors that were associated with the functional outcomes of the patients, such as concomitant fracture, post-operative complications, and post-operative intensive care unit (ICU) admissions [ 14 , 15 , 16 , 17 , 18 , 19 ], but incorporated certain factors that were not routinely collected in practice, such as the mental status examination (MSE), and, thus, were irrelevant and impractical [ 20 ]. In this study, we intended to develop a simplified clinical score to predict the risk of poor ambulation or being unable to bear self-weight at discharge in patients with fragility femoral neck fractures.…”

Factors predictive of functional outcomes in patients with fragility hip fracture

“…There have been relatively many studies on mortality and ambulatory function after surgery according to fracture type [24,[29][30][31][32][33][34][35][36]. There was study that showed no difference in mortality or function according to fracture type [36], and there were rare reports that intertrochanteric fracture had worse function [29,35], but overall, intertrochanteric fracture reported worse initial function [24,30], mortality [31,32] and functional outcomes [24,30,33,34].…”