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Which factors are independent predictors of early recovery of mobility in the older adults’ population after hip fracture? A cohort prognostic study

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of the present study was to identify all factors that might influence the short-term recovery of mobility in older adults’ patients after hip surgery.

Methods

A prospective cohort prognostic study was carried out. The study enrolled all consecutive patients aged 65 years or over admitted for hip fracture due to fragility. Patients were monitored from their admission into the emergency department of the hospital, until their discharge. The level of mobility was measured by the ILOA scale, administered during the 6th day of hospitalisation. The identified variables were divided into baseline patient variables, linked to the patient’s characteristics, and, healthcare/hospital variables, linked to the program of care within post-surgery hospitalisation.

Results

The total number of patients enrolled and examined at discharge was 484. Six days after surgery, the level of mobility achieved by patients, as measured by ILOA Scale, was 42.4 (± 6.0). Increased age (B = 0.111; p = 0,042), pressure sore mattress with a motor used (B = 3.817; p < 0.0005), delay in achieving an upright position (B = 0.509; p < 0.0005), no recovery of walking (b = 2.339; p < 0.0005), prolonged use of diapers (B = 0.004; p < 0.0005) or catheter (B = 0.089; p < 0.0005), indication for no weight bearing (B = 2.023; p = 0.031), and temperature for fewer days (B = 0.040; p = 0.023) are factors able to affect negatively recovery of mobility in the initial post-operative period in patients surgically treated for hip fracture.

Conclusion

Therapy and physiotherapy choices after surgery for hip fracture are significantly associated with early recovery of mobility of older adults’ patients, regardless of their baseline conditions. Early removal of supporting devices promoting prolonged bed immobility, such as air mattress, catheter, and incontinence pad, together with achieving an early upright position, are elements to take into account when planning future trials to understand its efficacy in enabling better recovery of mobility.

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References

  1. Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 8(3):1–17

    Google Scholar 

  2. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J et al (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182(15):1609–1616. doi:10.1503/cmaj.092220

    Article  PubMed  PubMed Central  Google Scholar 

  3. Van Balen R, Essink-Bot ML, Steyerberg E, Cools H, Habbema DF (2003) Quality of life after hip fracture: a comparison of four health status measures in 208 patients. Disabil Rehabil 25(10):507–519. doi:10.1080/0963828031000090443

    Article  PubMed  Google Scholar 

  4. Vochteloo AJ, Moerman S, Tuinebreijer WE, Maier AB, de Vries MR, Bloem RM et al (2013) More than half of hip fracture patients do not regain mobility in the first postoperative year. Geriatr Gerontol Int 13(2):334–341. doi:10.1111/j.1447-0594.2012.00904.x

    Article  PubMed  Google Scholar 

  5. Scottish Intercollegiate Guideline Network (SIGN). Management of hip fracture in older people. A national guideline. http://www.sign.ac.uk/guidelines/fulltext/111/. Accessed 10 May 2017

  6. National Insitute for Health and Care Excellence. Hip fracture: management. www.nice.org.uk/guidance/cg124. Accessed 10 May 2017

  7. Laflamme GY, Rouleau DM, Leduc S, Roy L, Beaumont E (2012) The timed up and go test is an early predictor of functional outcome after hemiarthroplasty for femoral neck fracture. J Bone Joint Surg Am 94(13):1175–1179. doi:10.2106/JBJS.J.01952

    Article  PubMed  Google Scholar 

  8. Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG (2003) Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol A Biol Sci Med Sci 58(11):1042–1045

    Article  PubMed  Google Scholar 

  9. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ (2006) No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg 76(7):607–611. doi:10.1111/j.1445-2197.2006.03786.x

    Article  PubMed  Google Scholar 

  10. Sanguineti VA, Wild JR, Fain MJ (2014) Management of postoperative complications: general approach. Clin Geriatr Med 30(2):261–270. doi:10.1016/j.cger.2014.01.005

    Article  PubMed  Google Scholar 

  11. Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 166(7):766–771. doi:10.1001/archinte.166.7.766

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim SM, Moon YW, Lim SJ, Yoon BK, Min YK, Lee DY et al (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50(6):1343–1350. doi:10.1016/j.bone.2012.02.633

    Article  PubMed  Google Scholar 

  13. Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira Daudi E, Salcedo Mahiques E, Cuesta Peredó D, Doménech-Pascual JR et al (2015) Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture. Geriatr Gerontol Int 15(3):289–295

    Article  PubMed  Google Scholar 

  14. Buecking B, Bohl K, Eschbach D, Bliemel C, Aigner R, Balzer-Geldsetzer M et al (2015) Factors influencing the progress of mobilization in hip fracture patients during the early postsurgical period?-A prospective observational study. Arch Gerontol Geriatr 60(3):457–463. doi:10.1016/j.archger.2015.01.017

    Article  PubMed  Google Scholar 

  15. Martín-Martín LM, Arroyo-Morales M, Sánchez-Cruz JJ, Valenza-Demet G, Valenza MC, Jiménez-Moleón JJ (2015) Factors influencing performance-oriented mobility after hip fracture. J Aging Health 27(5):827–842. doi:10.1177/0898264315569451

    Article  PubMed  Google Scholar 

  16. Bellelli G, Noale M, Guerini F, Turco R, Maggi S, Crepaldi G et al (2012) A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy. Osteoporos Int 23(8):2189–2200

    Article  CAS  PubMed  Google Scholar 

  17. Shields RK, Enloe LJ, Evans RE, Smith KB, Steckel SD (1995) Reliability, validity, and responsiveness of functional tests in patient with total joint replacement. Phys Ther 75(3):169–176

    Article  CAS  PubMed  Google Scholar 

  18. Sousa VD, Rojjanasrirat W (2011) Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 17:268–274

    Article  PubMed  Google Scholar 

  19. Pashikanti L, Von Ah D (2012) Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clin Nurse Spec 26(2):87–94. doi:10.1097/NUR.0b013e31824590e6

    Article  PubMed  Google Scholar 

  20. Barone A, Giusti A, Pizzonia M, Razzano M, Oliveri M, Palummeri E et al (2009) Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair. Arch Phys Med Rehabil 90(9):1495–1498. doi:10.1016/j.apmr.2009.03.013

    Article  PubMed  Google Scholar 

  21. Stansby G, Avital L, Jones K, Marsden G, Guideline Development Group (2014) Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance. BMJ 348:g2592

    Article  PubMed  Google Scholar 

  22. Roe B, Flanagan L, Maden M (2015) Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes. J Adv Nurs 71(7):1464–1483. doi:10.1111/jan.12613

    Article  PubMed  Google Scholar 

  23. Grigoryan KV, Javedan H, Rudolph JL (2014) Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28:e49–e55. doi:10.1097/BOT.0b013e3182a5a045

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gosch M, Hoffmann-Weltin Y, Roth T, Blauth M, Nicholas JA, Kammerlander C (2016) Orthogeriatric co-management improves the outcome of long-term care residents with fragility fractures. Arch Orthop Trauma Surg 136:1403–1409. doi:10.1007/s00402-016-2543-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Prestmo A, Saltvedt I, Helbostad JL, Taraldsen K, Thingstad P, Lydersen S, Sletvold O (2016) Who benefits from orthogeriatric treatment? Results from the Trondheim hip-fracture trial. BMC Geriatr 19(16):49. doi:10.1186/s12877-016-0218-1

    Article  Google Scholar 

  26. Heikkinen T, Partanen J, Ristiniemi J, Jalovaara P (2005) Evaluation of 238 consecutive patients with the extended data set of the Standardised Audit for Hip Fractures in Europe (SAHFE). Disabil Rehabil 27(18–19):1107–1115

    Article  CAS  PubMed  Google Scholar 

  27. Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14(7):798–804. doi:10.1111/j.1365-2702.2005.01121.x

    Article  PubMed  Google Scholar 

  28. Costardi D, Rozzini L, Costanzi C, Ghianda D, Franzoni S, Padovani A et al (2007) The Italian version of the pain assessment in advanced dementia (PAINAD) scale. Arch Gerontol Geriatr 44(2):175–180. doi:10.1016/j.archger.2006.04.008

    Article  CAS  PubMed  Google Scholar 

  29. Chen Q, Kane RL (2001) Effects of using consumer and expert ratings of an activities of daily living scale on predicting functional outcomes of postacute care. J Clin Epidemiol 54(4):334–342

    Article  CAS  PubMed  Google Scholar 

  30. De Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56:221–229

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Istituto Ortopedico Rizzoli, Servizio Assistenziale Infermieristico Tecnico e Riabilitativo Bologna, Via Pupilli 1, 40136, Bologna, Italy

    Mattia Morri, Cristiana Forni, Maura Marchioni, Elena Bonetti, Francesca Marseglia & Andrea Cotti

Authors
  1. Mattia Morri
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  2. Cristiana Forni
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  3. Maura Marchioni
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  4. Elena Bonetti
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  5. Francesca Marseglia
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Correspondence to Mattia Morri.

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All procedures performed in studies involving human participants were in accordance with the ethics standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethics standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no potential conflict of interest.

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Morri, M., Forni, C., Marchioni, M. et al. Which factors are independent predictors of early recovery of mobility in the older adults’ population after hip fracture? A cohort prognostic study. Arch Orthop Trauma Surg 138, 35–41 (2018). https://doi.org/10.1007/s00402-017-2803-y

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  • DOI: https://doi.org/10.1007/s00402-017-2803-y

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