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The journal of nutrition, health & aging

, Volume 23, Issue 10, pp 1034–1042 | Cite as

Functional Outcomes of Fragility Fracture Integrated Rehabilitation Management in Sarcopenic Patients after Hip Fracture Surgery and Predictors of Independent Ambulation

  • S.-K. Lim
  • J. Beom
  • S. Y. Lee
  • Jae-Young LimEmail author
Article

Abstract

Objectives

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.

Design

Prospective observational study.

Setting

Three in-hospital rehabilitation setting.

Participants

Patients older than 65 years of age (N=80) categorized by the presence of sarcopenia.

Intervention

The FIRM program during the-2 week hospital stay after surgery.

Measurements

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.

Results

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.

Conclusions

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 words

Clinical pathways geriatrics hip fractures rehabilitation sarcopenia 

Notes

Acknowledgements

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[1860]), and Jeju National University Hospital (JEJUNUH 2016-11-001), and written informed consent was obtained from all participants.

References

  1. 1.
    Elliott J, Beringer T, Kee F, et al. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol. 2003;56(8):788–795. doi:  https://doi.org/10.1016/S0895-4356(03)00129-X CrossRefGoogle Scholar
  2. 2.
    Dyer SM, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16(1):158. doi:  https://doi.org/10.1186/s12877-016-0332-0 CrossRefGoogle Scholar
  3. 3.
    Beaupre LA, Cinats JG, Senthilselvan A, et al. Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway. Qual Saf Health Care. 2006;15(5):375–379. doi:  https://doi.org/10.1136/qshc.2005.017095 CrossRefGoogle Scholar
  4. 4.
    Koval KJ, Cooley MR. Clinical pathway after hip fracture. Disabil Rehabil. 2005;27(18–19):1053–1060. doi:  https://doi.org/10.1080/09638280500056618 CrossRefGoogle Scholar
  5. 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
  6. 6.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–423. doi:  https://doi.org/10.1093/ageing/afq034 CrossRefGoogle Scholar
  7. 7.
    Landi F, Calvani R, Cesari M, et al. Sarcopenia as the Biological Substrate of Physical Frailty. Clin Geriatr Med. 2015;31(3):367–374. doi:  https://doi.org/10.1016/j.cger.2015.04.005 CrossRefGoogle Scholar
  8. 8.
    Landi F, Calvani R, Ortolani E, et al. The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int. 2017;28(5):1569–1576. doi:  https://doi.org/10.1007/s00198-017-3929-z CrossRefGoogle Scholar
  9. 9.
    Gonzalez-Montalvo JI, Alarcon T, Gotor P, et al. Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int. 2016;16(9):1021–1027. doi:  https://doi.org/10.1111/ggi.12590 CrossRefGoogle Scholar
  10. 10.
    Steihaug OM, Gjesdal CG, Bogen B, et al. Does sarcopenia predict change in mobility after hip fracture? a multicenter observational study with one-year follow-up. BMC Geriatr. 2018;18(1):65. doi:  https://doi.org/10.1186/s12877-018-0755-x CrossRefGoogle Scholar
  11. 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
  12. 12.
    Morandi A, Onder G, Fodri L, et al. The Association Between the Probability of Sarcopenia and Functional Outcomes in Older Patients Undergoing In-Hospital Rehabilitation. J Am Med Dir Assoc. 2015;16(11):951–956. doi:  https://doi.org/10.1016/j.jamda.2015.05.010 CrossRefGoogle Scholar
  13. 13.
    Roffman CE, Buchanan J, Allison GT. Charlson Comorbidities Index. J Physiother. 2016;62(3):171. doi:  https://doi.org/10.1016/j.jphys.2016.05.008 CrossRefGoogle Scholar
  14. 14.
    Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101. doi:  https://doi.org/10.1016/j.jamda.2013.11.025 CrossRefGoogle Scholar
  15. 15.
    Lukaski HC, Johnson PE, Bolonchuk WW, et al. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. The American journal of clinical nutrition. 1985;41(4):810–817. doi:  https://doi.org/10.1093/ajcn/41.4.810 CrossRefGoogle Scholar
  16. 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
  17. 17.
    Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23(6):1430–1453. doi:  https://doi.org/10.1016/j.clnu.2004.09.012 CrossRefGoogle Scholar
  18. 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
  19. 19.
    Holden MK, Gill KM, Magliozzi MR, et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984;64(1):35–40. doi:  https://doi.org/10.1093/ptj/64.1.35 CrossRefGoogle Scholar
  20. 20.
    Lennon S, Johnson L. The modified rivermead mobility index: validity and reliability. Disabil Rehabil. 2000;22(18):833–839. doi:  https://doi.org/10.1080/09638280050207884 CrossRefGoogle Scholar
  21. 21.
    Berg K, Wood-Dauphine S, Williams J, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304–311. doi:  https://doi.org/10.3138/ptc.41.6.304 CrossRefGoogle Scholar
  22. 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. 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
  24. 24.
    Group E. EuroQol-a new facility for the measurement of health-related quality of life. Health policy. 1990;16(3):199–208.CrossRefGoogle Scholar
  25. 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. 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
  27. 27.
    Jung HW, Yoo HJ, Park SY, et al. The Korean version of the FRAIL scale: clinical feasibility and validity of assessing the frailty status of Korean elderly. Korean J Intern Med. 2016;31(3):594–600. doi:  https://doi.org/10.3904/kjim.2014.331 CrossRefGoogle Scholar
  28. 28.
    Lee DY, Lee KU, Lee JH, et al. A normative study of the CERAD neuropsychological assessment battery in the Korean elderly. J Int Neuropsychol Soc. 2004;10(1):72–81. doi:  https://doi.org/10.1017/S1355617704101094 CrossRefGoogle Scholar
  29. 29.
    Tang VL, Sudore R, Cenzer IS, et al. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med. 2017;32(2):153–158. doi:  https://doi.org/10.1007/s11606-016-3848-2 CrossRefGoogle Scholar
  30. 30.
    Magaziner J, Fredman L, Hawkes W, et al. Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol. 2003;157(11):1023–1031. doi:  https://doi.org/10.1093/aje/kwg081 CrossRefGoogle Scholar
  31. 31.
    Bachmann S, Finger C, Huss A, et al. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340:c1718. doi:  https://doi.org/10.1136/bmj.c1718 CrossRefGoogle Scholar
  32. 32.
    Kristensen MT, Foss NB, Ekdahl C, et al. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop. 2010;81(3):296–302. doi:  https://doi.org/10.3109/17453674.2010.487240 CrossRefGoogle Scholar
  33. 33.
    Hirose J, Ide J, Yakushiji T, et al. Prediction of postoperative ambulatory status 1 year after hip fracture surgery. Arch Phys Med Rehabil. 2010;91(1):67–72. doi:  https://doi.org/10.1016/j.apmr.2009.09.018 CrossRefGoogle Scholar
  34. 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
  35. 35.
    Svensson O, Stromberg L, Ohlen G, et al. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br. 1996;78(1):115–118. doi:  https://doi.org/10.1302/0301-620X.78B1.0780115 CrossRefGoogle Scholar
  36. 36.
    Savino E, Martini E, Lauretani F, et al. Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med. 2013;126(12):1068–1075 e1061. doi:  https://doi.org/10.1016/j.amjmed.2013.04.017 CrossRefGoogle Scholar
  37. 37.
    Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006; https://doi.org/10.1002/14651858.CD001708.pub2(4):CD001708. doi:  https://doi.org/10.1002/14651858.CD001708.pub2 Google Scholar
  38. 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. 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
  40. 40.
    Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990;45(3):M101–107. doi:  https://doi.org/10.1093/geronj/45.3.M101 CrossRefGoogle Scholar
  41. 41.
    Heikkinen T, Jalovaara P. Four or twelve months’ follow-up in the evaluation of functional outcome after hip fracture surgery? Scand J Surg. 2005;94(1):59–66. doi:  https://doi.org/10.1177/145749690509400115 CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  • S.-K. Lim
    • 1
  • J. Beom
    • 2
  • S. Y. Lee
    • 3
  • Jae-Young Lim
    • 4
    • 5
    • 6
    Email author
  1. 1.Department of Physical Medicine and RehabilitationGyeongsang National University Changwon Hospital, Gyeongsang National University School of MedicineChangwonRepublic of Korea
  2. 2.Department of Physical Medicine and RehabilitationChung-Ang University Hospital, Chung-Ang University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Rehabilitation MedicineSMG-SNU Boramae Medical CenterSeoulRepublic of Korea
  4. 4.Department of Rehabilitation MedicineSeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamRepublic of Korea
  5. 5.Institute on AgingSeoul National UniversitySeoulRepublic of Korea
  6. 6.Seoul National University College of Medicine, Seoul National University Bundang HospitalSeongnam, Gyeonggi-doRepublic of Korea

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