Functional Outcomes of Fragility Fracture Integrated Rehabilitation Management in Sarcopenic Patients after Hip Fracture Surgery and Predictors of Independent Ambulation
To compare the changes in the functional level of patients with versus without sarcopenia who received by fragility fracture integrated rehabilitation management (FIRM) after hip fracture (HF) surgery over a 6-month follow-up period and to identify variables influencing independent ambulation (IA) at 6 months after HF.
Prospective observational study.
Three in-hospital rehabilitation setting.
Patients older than 65 years of age (N=80) categorized by the presence of sarcopenia.
The FIRM program during the-2 week hospital stay after surgery.
Main outcomes for ambulatory function (Koval score, Functional Ambulatory Category) and other secondary outcomes were measured at rehabilitation admission, at discharge, at 3 months and 6 months after surgery. Other secondary outcomes were measured. The possibility of IA at 6 months after surgery were also investigated.
Sarcopenia and non-sarcopenia patients did not differ significantly in terms of changes in ambulation or other functions over a 6-month follow-up (p < 0.001 or p = 0.001). The two groups did not differ significantly in terms of final functional status (6 months). The IA ratios of the two groups did not significantly differ at 6 months after surgery (sarcopenia [54.3%] and non-sarcopenia [64.5%]). IA before fracture (p = 0.039) and age (≥80 years) (p = 0.03) were independent predictors and sarcopenia was not a predictor for the possibility of IA at 6-months after surgery.
The FIRM program was effective for promoting functional recovery in older patients with fragility HF, either with or without sarcopenia. The present findings provide evidence of the pressing need for integrated rehabilitation management in fragility fracture care to improve functional recovery in patients with sarcopenia.
Key wordsClinical pathways geriatrics hip fractures rehabilitation sarcopenia
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Number: HC15C1189).
Conflict of interest: The authors have no conflicts of interest to disclose.
Ethical standards: This study was approved by the Institutional Review Boards of Seoul National University Bundang Hospital (B-1603-337-002), Chung-Ang University Hospital (C2016117), and Jeju National University Hospital (JEJUNUH 2016-11-001), and written informed consent was obtained from all participants.
- 5.Lee SY, Beom J, Kim BR, et al. Comparative effectiveness of fragility fracture integrated rehabilitation management for elderly individuals after hip fracture surgery: A study protocol for a multicenter randomized controlled trial. Medicine (Baltimore). 2018;97(20):e10763. doi: https://doi.org/10.1097/MD.0000000000010763 CrossRefGoogle Scholar
- 11.Lim S-K, Lee SY, Beom J, et al. Comparative outcomes of inpatient fragility fracture intensive rehabilitation management (FIRM) after hip fracture in sarcopenic and non-sarcopenic patients: a prospective observational study. European Geriatric Medicine. 2018;9(5):641–650. doi: https://doi.org/10.1007/s41999-018-0089-4 CrossRefGoogle Scholar
- 16.Coppini LZ, Waitzberg DL, Campos AC. Limitations and validation of bioelectrical impedance analysis in morbidly obese patients. Curr Opin Clin Nutr Metab Care. 2005;8(3):329–332. doi: https://doi.org/10.1097/01.mco.0000165013.54696.64 CrossRefGoogle Scholar
- 18.Koval KJ, Skovron ML, Aharonoff GB, et al. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res. 1995(310):150–159.Google Scholar
- 22.Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997;15(2):300–308.Google Scholar
- 23.Jung IK, Kwak DI, Joe SH, et al. A study of standardization of Korean form of Geriatric Depression Scale (KGDS). J Korean Geriatr Psychiatry. 1997;1(1):61–72.Google Scholar
- 25.Jung HY, Park BK, Shin HS, et al. Development of the Korean version of Modified Barthel Index (K-MBI): multi-center study for subjects with stroke. J Korean Acad Rehabil Med. 2007;31(3):283–297.Google Scholar
- 26.Won CW, Yang KY, Rho YG, et al. The development of Korean activities of daily living (K-ADL) and Korean instrumental activities of daily living (K-IADL) scale. J Korean Geriatr Soc. 2002;6(2):107–120.Google Scholar
- 34.Ishida Y, Kawai S, Taguchi T. Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures. Clin Orthop Relat Res. 2005; https://doi.org/10.1097/01.blo.0000159156.40002.30(436):208–215. doi: https://doi.org/10.1097/01.blo.0000159156.40002.30 CrossRefGoogle Scholar
- 38.Yoo JI, Ha YC, Lim JY, et al. Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis. J Korean Med Sci. 2017;32(5):858–867. doi: https://doi.org/10.3346/jkms.2017.32.5.858 CrossRefGoogle Scholar
- 39.Kristensen MT, Bandholm T, Bencke J, et al. Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture. Clin Biomech (Bristol, Avon). 2009;24(2):218–224. doi: https://doi.org/10.1016/j.clinbiomech.2008.10.003 CrossRefGoogle Scholar