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A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy

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Abstract

Summary

A score for identifying post-hip-fracture surgery patients at various levels (high, medium, and low) of risk for unsuccessful recovery of pre-fracture walking ability was developed. Three hundred ninety-eight HF patients were enrolled in the study. The score significantly and independently predicted failure to walk independently at discharge, failure to walk independently after 12 months, and death after 12 months. The score may be useful for clinicians and healthcare administrators to target populations for rehabilitative programs.

Introduction

To develop a model predicting at the time that elderly hip-fracture (HF) patients undergo rehabilitation if they will have recovered walking independence at discharge.

Methods

Data from all patients admitted to a Department of Rehabilitation in Italy between January 2001 and June 2008 after HF surgery were used. Variables concerning cognitive, clinical, functional, and social parameters were evaluated. Predominant measures were identified through correspondence analysis, and a variable score was defined. Three risk classes (minimum, moderate, and high) were identified and univariate and multivariate logistic regressions were used to assess the model's predictivity and risk classes for the various outcomes.

Results

Three hundred ninety-eight HF patients were enrolled. The variables selected to construct the score were age, gender, body mass index, number of drugs being taken, the Mini Mental State Examination, the Instrumental Activity of Daily Living, and the pre-fracture Barthel index. According to univariate analysis, the score was not better than the pre-fracture Barthel's index, but, according to multivariate analysis, it was an independent predictor for all the outcomes, while the pre-fracture Barthel index predicted only outcomes at discharge. In particular, the score significantly predicted failure to walk independently at discharge, failure to walk independently after 12 months, and death after 12 months.

Conclusions

A method of identifying post-HF surgery patients at various levels (high-, medium-, and low-) of risk for unsuccessful recovery of pre-fracture walking ability has been designed. The method may be useful for clinicians and healthcare administrators to target populations for rehabilitative programs.

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Acknowledgments

The authors wish to thank Dr. Sara Morghen for the management of database and Drs. Tiziana Torpilliesi, Alessandra Marrè, Eleonora Ricci Elena Lucchi, and Salvatore Speciale for collecting data. Sincere appreciation is due to the team of physical therapists for their support in rehabilitation activities and to Linda Inverso Moretti for reviewing the English version of this manuscript.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Clinical and Preventive Medicine, University of Milano-Bicocca, Geriatric Clinic, S. Gerardo Hospital, via Cadore 48, Monza, Italy

    G. Bellelli

  2. Department of Rehabilitation and Aged Care, Ancelle della Carità Hospital, via Aselli 14, Cremona, Italy

    G. Bellelli, F. Guerini & R. Turco

  3. Geriatric Research Group, via F.lli Lombardi2, Brescia, Italy

    G. Bellelli, F. Guerini, R. Turco & M. Trabucchi

  4. CNR, Institute of Neuroscience-Aging Branch, Padova, Italy

    M. Noale, S. Maggi & G. Crepaldi

  5. Tor Vergata University, Rome, Italy

    M. Trabucchi

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  1. G. Bellelli
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  2. M. Noale
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  3. F. Guerini
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  4. R. Turco
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  5. S. Maggi
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  6. G. Crepaldi
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  7. M. Trabucchi
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Correspondence to G. Bellelli.

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Bellelli, G., Noale, M., Guerini, F. et al. A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy. Osteoporos Int 23, 2189–2200 (2012). https://doi.org/10.1007/s00198-011-1849-x

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  • DOI: https://doi.org/10.1007/s00198-011-1849-x

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