Comparative outcomes of inpatient fragility fracture intensive rehabilitation management (FIRM) after hip fracture in sarcopenic and non-sarcopenic patients: a prospective observational study
To evaluate the effects of fragility fracture integrated rehabilitation management (FIRM) on the functional outcomes of sarcopenic and non-sarcopenic inpatients following hip fracture surgery.
This prospective observational study was carried out with patients over 65 years of age who underwent hip surgery for fragility hip fracture and received multidisciplinary rehabilitation. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria. Demographic and functional characteristics were analyzed before and after rehabilitation during inpatient care to evaluate short-term outcomes.
Sixty-eight patients were eligible for the study, and 32 (47.1%) satisfied the criteria for sarcopenia. The pre-fracture ambulatory status was lower in the sarcopenia group (KOVAL: 1.74 ± 1.42 vs. 1.22 ± 0.42, p = 0.022). The overall functional levels were significantly lower in the sarcopenia group before and after rehabilitation. Overall function was significantly improved in both groups after FIRM, and with the exception of Korean Instrumental Activities of Daily Living scores, there were no differences between the groups in the changes after FIRM. Pre-fracture independent ambulatory function was significantly correlated with short-term ambulatory functional recovery in both sarcopenia and non-sarcopenia groups [n = 22 (91.7%), p = 0.023 vs. n = 27 (84.4%), p = 0.028].
Our results suggest that FIRM was effective for short-term functional recovery in older patients with or without sarcopenia who have suffered fragility hip fracture. Considering sarcopenia, which has a detrimental effect on functional outcomes after rehabilitation, the impact of sarcopenia on FIRM should be investigated further over a longer period of time.
KeywordsClinical 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).
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
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. This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (B-1603-337-002) and Chung-Ang University Hospital [C2016117(1860)].
Written informed consent was obtained from all enrolled participants for FIRM.
- 2.Statistics Korea. Population Projections for Korea 2016Google Scholar
- 4.Kang HY, Yang KH, Kim YN, Moon SH, Choi WJ, Kang DR et al (2010) Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health 10:230. https://doi.org/10.1186/1471-2458-10-230 CrossRefPubMedCentralPubMedGoogle Scholar
- 8.Beaupre LA, Cinats JG, Senthilselvan A, Lier D, Jones CA, Scharfenberger A et al (2006) Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway. Qual Saf Health Care 15(5):375–379. https://doi.org/10.1136/qshc.2005.017095 CrossRefPubMedCentralPubMedGoogle Scholar
- 11.Morandi A, Onder G, Fodri L, Sanniti A, Schnelle J, Simmons S et al (2015) The association between the probability of sarcopenia and functional outcomes in older patients undergoing in-hospital rehabilitation. J Am Med Dir Assoc 16(11):951–956. https://doi.org/10.1016/j.jamda.2015.05.010 CrossRefPubMedGoogle Scholar
- 12.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423. https://doi.org/10.1093/ageing/afq034 CrossRefPubMedCentralPubMedGoogle Scholar
- 14.Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB et al (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69(5):547–558. https://doi.org/10.1093/gerona/glu010 CrossRefPubMedCentralPubMedGoogle Scholar
- 15.Kang Y, Na DL, Hahn S (1997) A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 15(2):300–308Google Scholar
- 19.Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD (1995) Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res 310:150–159Google Scholar
- 23.Jung IK, Kwak DI, Joe SH, Lee HS (1997) A study of standardization of Korean form of Geriatric Depression Scale (KGDS). J Korean Geriatr Psychiatry 1(1):61–72Google Scholar
- 25.Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ et al (2007) Development of the Korean version of Modified Barthel Index (K-MBI): multi-center study for subjects with stroke. J Korean Acad Rehabil Med 31(3):283–297Google Scholar
- 26.Won CW, Yang KY, Rho YG, Kim SY, Lee EJ, Yoon JL et al (2002) The development of Korean activities of daily living (K-ADL) and Korean instrumental activities of daily living (K-IADL) scale. J Korean Geriatr Soc. 6(2):107–120Google Scholar
- 29.Cruz-Jentoft AJ, Landi F, Schneider SM, Zuniga C, Arai H, Boirie Y et al (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 43(6):748–759. https://doi.org/10.1093/ageing/afu115 CrossRefPubMedCentralPubMedGoogle Scholar
- 32.Landi F, Calvani R, Ortolani E, Salini S, Martone AM, Santoro L et al (2017) The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int 28(5):1569–1576. https://doi.org/10.1007/s00198-017-3929-z CrossRefPubMedGoogle Scholar
- 33.Sánchez-Rodríguez D, Marco E, Miralles R, Fayos M, Mojal S, Alvarado M et al (2014) Sarcopenia, physical rehabilitation and functional outcomes of patients in a subacute geriatric care unit. Arch Gerontol Geriatr 59(1):39–43. https://doi.org/10.1016/j.archger.2014.02.009 CrossRefPubMedGoogle Scholar
- 39.Lenze EJ, Skidmore ER, Dew MA, Butters MA, Rogers JC, Begley A et al (2007) Does depression, apathy, or cognitive impairment reduce the benefit of inpatient rehabilitation facilities for elderly hip fracture patients? Gen Hosp Psychiatry 29(2):141–146. https://doi.org/10.1016/j.genhosppsych.2007.01.001 CrossRefPubMedCentralPubMedGoogle Scholar