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Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis

  • K. Fischer
  • M. Trombik
  • G. Freystätter
  • A. Egli
  • R. Theiler
  • H.A. Bischoff-FerrariEmail author
Original Article

Abstract

Summary

We investigated the timeline of functional recovery after hip fracture over 12 months in adults age ≥ 65 years using objective lower extremity function tests and subjective physical functioning. Objective functional recovery was largely complete in the first 6 months, whereas subjective recovery improved up to 9 months after hip fracture.

Introduction

Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture.

Methods

We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65 years (mean age 84 years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12 months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9 months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients.

Results

Lower extremity function including TUG (− 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6 months (P < 0.001). However, between 6 and 12 months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6 months (− 7.9%; P < 0.001) and from 6 to 12 months (− 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9 months (+ 15.2%, P < 0.001), but no longer thereafter.

Conclusions

Functional recovery after hip fracture may be largely complete in the first 6 months for objective functional tests, whereas may extend up to 9 months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly.

Clinical trials registry (original trial)

NCT00133640.

Keywords

Functional recovery Hip fracture Objective functional tests Subjective physical functioning Timeline 

Notes

Funding

This project was funded by the Baugarten Foundation Centre Grant for the Centre on Aging and Mobility (Dr. Bischoff-Ferrari). The original trial was supported by Swiss National Foundations (NFP-53) (Drs Bischoff-Ferrari and Theiler); Vontobel Foundation (Dr Bischoff-Ferrari; and Swiss National Foundations professorship grant PP00B-114864 (Dr Bischoff-Ferrari).

Compliance with ethical standards

Conflicts of interest

None.

Ethical approval

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

Supplementary material

198_2019_4944_MOESM1_ESM.pdf (5.7 mb)
ESM 1 (PDF 5819 kb)

References

  1. 1.
    da Costa JA, Ribeiro A, Bogas M, Costa L, Varino C, Lucas R, Rodrigues A, Araújo D (2009) Mortality and functional impairment after hip fracture—a prospective study in a Portuguese population. Acta Reumatol Port 34:618–626Google Scholar
  2. 2.
    Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51:364–370CrossRefGoogle Scholar
  3. 3.
    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650CrossRefGoogle Scholar
  4. 4.
    Barrett-Connor E (1995) The economic and human costs of osteoporotic fracture. Am J Med 98:3S–8SCrossRefGoogle Scholar
  5. 5.
    Leal J, Gray AM, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A, group Rs (2016) Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int 27:549–558CrossRefGoogle Scholar
  6. 6.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRefGoogle Scholar
  7. 7.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413CrossRefGoogle Scholar
  8. 8.
    Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289CrossRefGoogle Scholar
  9. 9.
    Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650CrossRefGoogle Scholar
  10. 10.
    Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507CrossRefGoogle Scholar
  11. 11.
    Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636CrossRefGoogle Scholar
  12. 12.
    Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stähelin HB, Willett WC, Can U, Egli A, Mueller NJ, Looser S, Bretscher B, Minder E, Vergopoulos A, Theiler R (2010) Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 170:813–820CrossRefGoogle Scholar
  13. 13.
    Paula Fde L, da Cunha GM, Leite Ida C, Pinheiro RS, Valente JG (2015) Elderly readmission and death after discharge from treatment of hip fracture, occurred in public hospitals from 2008 to 2010, Rio de Janeiro. Rev Bras Epidemiol 18:439–453CrossRefGoogle Scholar
  14. 14.
    Kates SL, Behrend C, Mendelson DA, Cram P, Friedman SM (2015) Hospital readmission after hip fracture. Arch Orthop Trauma Surg 135:329–337CrossRefGoogle Scholar
  15. 15.
    Boockvar KS, Halm EA, Litke A, Silberzweig SB, McLaughlin M, Penrod JD, Magaziner J, Koval K, Strauss E, Siu AL (2003) Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc 51:399–403CrossRefGoogle Scholar
  16. 16.
    Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45:M101–M107CrossRefGoogle Scholar
  17. 17.
    Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML (2015) Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick hip trauma evaluation—a prospective cohort study. Bone Joint J 97-B:372–382CrossRefGoogle Scholar
  18. 18.
    Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250CrossRefGoogle Scholar
  19. 19.
    Vochteloo AJ, Moerman S, Tuinebreijer WE, Maier AB, de Vries MR, Bloem RM, Nelissen RG, Pilot P (2013) More than half of hip fracture patients do not regain mobility in the first postoperative year. Geriatr Gerontol Int 13:334–341CrossRefGoogle Scholar
  20. 20.
    Colón-Emeric CS, Saag KG (2006) Osteoporotic fractures in older adults. Best Pract Res Clin Rheumatol 20:695–706CrossRefGoogle Scholar
  21. 21.
    Hannan EL, Magaziner J, Wang JJ, Eastwood EA, Silberzweig SB, Gilbert M, Morrison RS, McLaughlin MA, Orosz GM, Siu AL (2001) Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 285:2736–2742CrossRefGoogle Scholar
  22. 22.
    Heikkinen T, Jalovaara P (2005) Four or twelve months’ follow-up in the evaluation of functional outcome after hip fracture surgery? Scand J Surg 94:59–66CrossRefGoogle Scholar
  23. 23.
    Latham NK, Harris BA, Bean JF, Heeren T, Goodyear C, Zawacki S, Heislein DM, Mustafa J, Pardasaney P, Giorgetti M, Holt N, Goehring L, Jette AM (2014) Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. JAMA 311:700–708CrossRefGoogle Scholar
  24. 24.
    Córcoles-Jiménez MP, Villada-Munera A, Del Egido-Fernández M, Candel-Parra E, Moreno-Moreno M, Jiménez-Sánchez MD, Piña-Martínez A (2015) Recovery of activities of daily living among older people one year after hip fracture. Clin Nurs Res 24:604–623CrossRefGoogle Scholar
  25. 25.
    Vochteloo AJ, van Vliet-Koppert ST, Maier AB, Tuinebreijer WE, Röling ML, de Vries MR, Bloem RM, Nelissen RG, Pilot P (2012) Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients. Arch Orthop Trauma Surg 132:823–830CrossRefGoogle Scholar
  26. 26.
    Mariconda M, Costa GG, Cerbasi S, Recano P, Aitanti E, Gambacorta M, Misasi M (2015) The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study. Bone Joint J 97-B:383–390CrossRefGoogle Scholar
  27. 27.
    Givens JL, Sanft TB, Marcantonio ER (2008) Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 56:1075–1079CrossRefGoogle Scholar
  28. 28.
    Penrod JD, Boockvar KS, Litke A, Magaziner J, Hannan EL, Halm EA, Silberzweig SB, Sean Morrison R, Orosz GM, Koval KJ, Siu AL (2004) Physical therapy and mobility 2 and 6 months after hip fracture. J Am Geriatr Soc 52:1114–1120CrossRefGoogle Scholar
  29. 29.
    Latham NK, Mehta V, Nguyen AM, Jette AM, Olarsch S, Papanicolaou D, Chandler J (2008) Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients? Arch Phys Med Rehabil 89:2146–2155CrossRefGoogle Scholar
  30. 30.
    Cleary PD (1997) Subjective and objective measures of health: which is better when? J Health Serv Res Policy 2:3–4CrossRefGoogle Scholar
  31. 31.
    Stemmle J, Marzel A, Chocano-Bedoya PO, Orav EJ, Dawson-Hughes B, Freystaetter G, Egli A, Theiler R, Staehelin HB, Bischoff-Ferrari HA (2018) Effect of 800 IU versus 2000 IU vitamin D3 with or without a simple home exercise program on functional recovery after hip fracture: a randomized controlled trial. J Am Med Dir AssocGoogle Scholar
  32. 32.
    Nardi M, Fischer K, Dawson-Hughes B, Orav EJ, Meyer OW, Meyer U, Beck S, Simmen HP, Pape HC, Egli A, Willett WC, Theiler R, Bischoff-Ferrari HA (2018) Association between caregiver role and short- and long-term functional recovery after hip fracture: a prospective study. J Am Med Dir Assoc 19:122–129CrossRefGoogle Scholar
  33. 33.
    Bischoff HA, Stahelin HB, Dick W et al (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351CrossRefGoogle Scholar
  34. 34.
    Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRefGoogle Scholar
  35. 35.
    Bischoff HA, Stahelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, Akos R, Conzelmann M, Dick W, Theiler R (2003) Identifying a cut-off point for normal mobility: a comparison of the timed 'up and go' test in community-dwelling and institutionalised elderly women. Age Ageing 32:315–320CrossRefGoogle Scholar
  36. 36.
    Madsen OR, Lauridsen UB (1995) Knee extensor and flexor strength in elderly women after recent hip fracture: assessment by the Cybex 6000 dynamometer of intra-rater inter-test reliability. Scand J Rehabil Med 27:219–226Google Scholar
  37. 37.
    Stoll T (2002) Isometric muscle strength measurement. ThiemeGoogle Scholar
  38. 38.
    Desrosiers J, Bravo G, Hébert R, Dutil E (1995) Normative data for grip strength of elderly men and women. Am J Occup Ther 49:637–644CrossRefGoogle Scholar
  39. 39.
    Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefGoogle Scholar
  40. 40.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  41. 41.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefGoogle Scholar
  42. 42.
    Tseng MY, Shyu YI, Liang J (2012) Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Gerontologist 52:833–842CrossRefGoogle Scholar
  43. 43.
    Beaupre LA, Jones CA, Johnston DW, Wilson DM, Majumdar SR (2012) Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: prospective cohort study. J Am Geriatr Soc 60:1268–1273CrossRefGoogle Scholar
  44. 44.
    Visser M, Harris TB, Fox KM, Hawkes W, Hebel JR, Yahiro JY, Michael R, Zimmerman SI, Magaziner J (2000) Change in muscle mass and muscle strength after a hip fracture: relationship to mobility recovery. J Gerontol A Biol Sci Med Sci 55:M434–M440CrossRefGoogle Scholar
  45. 45.
    Beseler MR, Rubio C, Duarte E, Hervás D, Guevara MC, Giner-Pascual M, Viosca E (2014) Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients. Clin Interv Aging 9:1873–1877CrossRefGoogle Scholar
  46. 46.
    Savino E, Martini E, Lauretani F, Pioli G, Zagatti AM, Frondini C, Pellicciotti F, Giordano A, Ferrari A, Nardelli A, Davoli ML, Zurlo A, Lunardelli ML, Volpato S (2013) Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med 126:1068–1075.e1061CrossRefGoogle Scholar
  47. 47.
    Felicio DC, Pereira DS, Assumpção AM, de Jesus-Moraleida FR, de Queiroz BZ, da Silva JP, de Brito Rosa NM, Dias JM, Pereira LS (2014) Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women. Geriatr Gerontol Int 14:185–189CrossRefGoogle Scholar
  48. 48.
    Muangpaisan W, Wongprikron A, Srinonprasert V, Suwanpatoomlerd S, Sutipornpalangkul W, Assantchai P (2015) Incidence and risk factors of acute delirium in older patients with hip fracture in Siriraj Hospital. J Med Assoc Thail 98:423–430Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • K. Fischer
    • 1
    • 2
  • M. Trombik
    • 1
    • 2
  • G. Freystätter
    • 1
    • 2
    • 3
  • A. Egli
    • 1
    • 2
  • R. Theiler
    • 1
    • 2
    • 3
  • H.A. Bischoff-Ferrari
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of Geriatrics and Aging Research, Geriatric ClinicUniversity Hospital Zurich and University of ZurichZurichSwitzerland
  2. 2.Centre on Aging and MobilityUniversity Hospital Zurich and City Hospital WaidZurichSwitzerland
  3. 3.Centre for Senior Trauma CareUniversity Hospital ZurichZurichSwitzerland
  4. 4.City Hospital WaidUniversity Clinic for Acute Geriatric CareZurichSwitzerland

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