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Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review

  • K. K. LimEmail author
  • D. B. Matchar
  • J. L. Chong
  • W. Yeo
  • T. S. Howe
  • J. S. B. Koh
Review Article

Abstract

Introduction

To identify, organize, and assess the evidence level of pre-discharge prognostic factors of physical function beyond discharge after hip fracture surgery.

Methods

We performed a systematic search of four databases (PubMed, Embase, CINAHL, PsycINFO) for longitudinal studies of prognostic factors of physical function at ≥ 1 month among older adults ≥ 50 years old with surgically treated hip fracture, complemented with hand-searching. Two reviewers independently screened papers for inclusion and assessed the quality of all the included papers using the Quality in Prognosis Studies (QUIPS) tool. We assigned the evidence level for each prognostic factor based on consistency in findings and study quality.

Results

From 98 papers that met our inclusion criteria, we identified 107 pre-discharge prognostic factors and organized them into the following seven categories: demographic, physical, cognitive, psychosocial, socioeconomic, injury-related, and process of care. Potentially modifiable factors with strong or moderate evidence of an association included total length of stay, physical function at discharge, and grip strength. Factors with strong or moderate evidence of no association included gender, fracture type, and time to surgery. Factors with limited, conflicting, or inconclusive evidence included body-mass index, psychological resilience, depression, and anxiety.

Conclusions

Our findings highlight potentially modifiable prognostic factors that could be targeted and non-modifiable prognostic factors that could be used to identify patients who may benefit from more intensive intervention or to advise patients on their expectations on recovery. Examining the efficacies of existing interventions targeting these prognostic factors would inform future studies and whether any of such interventions could be incorporated into clinical practice.

Keywords

Elderly Hip fracture Older adults Physical function Prognostic factors Systematic review 

Notes

Acknowledgements

We would like to thank Suei Nee Wong (medical librarian) for her help in refining our search strategies.

Compliance with ethical standards

Conflict of interest

Ka Keat Lim, David Bruce Matchar, Jia Loon Chong, William Yeo, Tet Sen Howe, and Joyce SB Koh declare that they have no conflict of interest.

Supplementary material

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Programme in Health Services & Systems ResearchDuke–NUS Medical SchoolSingaporeRepublic of Singapore
  2. 2.Department of Medicine (General Internal Medicine)Duke University Medical CenterDurhamUSA
  3. 3.Orthopaedic Diagnostic Centre, Department of Orthopaedic SurgerySingapore General HospitalSingaporeRepublic of Singapore
  4. 4.Department of Orthopaedic SurgerySingapore General HospitalSingaporeRepublic of Singapore
  5. 5.Duke–NUS Medical SchoolSingaporeRepublic of Singapore

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