Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review
To identify, organize, and assess the evidence level of pre-discharge prognostic factors of physical function beyond discharge after hip fracture surgery.
We performed a systematic search of four databases (PubMed, Embase, CINAHL, PsycINFO) for longitudinal studies of prognostic factors of physical function at ≥ 1 month among older adults ≥ 50 years old with surgically treated hip fracture, complemented with hand-searching. Two reviewers independently screened papers for inclusion and assessed the quality of all the included papers using the Quality in Prognosis Studies (QUIPS) tool. We assigned the evidence level for each prognostic factor based on consistency in findings and study quality.
From 98 papers that met our inclusion criteria, we identified 107 pre-discharge prognostic factors and organized them into the following seven categories: demographic, physical, cognitive, psychosocial, socioeconomic, injury-related, and process of care. Potentially modifiable factors with strong or moderate evidence of an association included total length of stay, physical function at discharge, and grip strength. Factors with strong or moderate evidence of no association included gender, fracture type, and time to surgery. Factors with limited, conflicting, or inconclusive evidence included body-mass index, psychological resilience, depression, and anxiety.
Our findings highlight potentially modifiable prognostic factors that could be targeted and non-modifiable prognostic factors that could be used to identify patients who may benefit from more intensive intervention or to advise patients on their expectations on recovery. Examining the efficacies of existing interventions targeting these prognostic factors would inform future studies and whether any of such interventions could be incorporated into clinical practice.
KeywordsElderly Hip fracture Older adults Physical function Prognostic factors Systematic review
We would like to thank Suei Nee Wong (medical librarian) for her help in refining our search strategies.
Compliance with ethical standards
Conflict of interest
Ka Keat Lim, David Bruce Matchar, Jia Loon Chong, William Yeo, Tet Sen Howe, and Joyce SB Koh declare that they have no conflict of interest.
- 1.Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, Künn-Nelen A, Pettersson-Kymmer U, Eriksson S, Brenner H, Schöttker B, Saum KU, Holleczek B, Grodstein FD, Feskanich D, Orsini N, Wolk A, Bellavia A, Wilsgaard T, Jørgensen L, Boffetta P, Trichopoulos D, Trichopoulou A (2017) Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health 2(5):e239–e246CrossRefGoogle Scholar
- 4.Kanis JA, On behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at primary health-care level. World Health Organization, BelgiumGoogle Scholar
- 7.National Clinical Guideline Centre (2011) The management of hip fracture in adults. National Clinical Guideline Centre, London, UKGoogle Scholar
- 9.Handoll HHG et al (2009) Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 4:CD007125. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007125.pub2/full
- 12.Handoll HH, Sherrington C, Mak JC (2011) Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 3:CD001704. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001704.pub4/full
- 22.Lim KK, Chong JL, Matchar D (2017) Prognostic factors of physical function and mortality after hip fracture surgery: a systematic review and meta-analysis. Available from: https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017054196. Accessed 20 May 2018
- 23.de Rooij M, van der Leeden M, Heymans MW, Holla JFM, Häkkinen A, Lems WF, Roorda LD, Veenhof C, Sanchez-Ramirez DC, de Vet HCW, Dekker J (2016) Prognosis of pain and physical functioning in patients with knee osteoarthritis: a systematic review and meta-analysis. Arthritis Care Res 68(4):481–492CrossRefGoogle Scholar
- 24.World Health Organization (2018) International classification of functioning, disability and health (ICF). Available from: http://www.who.int/classifications/icf/en/. Accessed 28 March 2018
- 26.Hoang-Kim A, Schemitsch E, Kulkarni AV, Beaton D (2014) Methodological challenges in the use of hip-specific composite outcomes: linking measurements from hip fracture trials to the International Classification of Functioning, Disability and Health Framework. Arch Orthop Trauma Surg 134(2):219–228CrossRefGoogle Scholar
- 34.Ruiz BAA (1992) Hip fracture recovery in older women: the influence of self-efficacy, depressive symptoms and state anxiety (dissertation). University of California, San Francisco, Ann Arbor, MIGoogle Scholar
- 35.Dawson DK (2000) Determinants of nonrecovery following hip fracture in older adults: a chronic disease trajectory analysis. Virginia Polytechnic Institute and State University, Clarksville, VAGoogle Scholar
- 37.American Academy of Orthopaedic Surgeons (2014) Management of hip fractures in the elderly: evidence-based clinical practice guideline. American Academy of Orthopaedic Surgeons, IllinoisGoogle Scholar
- 38.Mountain G, Windle G, Hind D, Walters S, Keertharuth A, Chatters R, Sprange K, Craig C, Cook S, Lee E, Chater T, Woods R, Newbould L, Powell L, Shortland K, Roberts J (2017) A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial. Age Ageing 46(4):627–634CrossRefGoogle Scholar
- 39.Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, Mawdesley K, Hawkes CA, Morrison V, Lemmey A, Edwards RT, Hoare Z, Pritchard AW, Woods RT, Alexander S, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J (2017) Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technol Assess 21(44):1–528CrossRefGoogle Scholar
- 45.Smith TO et al (2015) Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery. Cochrane Database Syst Rev 6:CD010569. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010569.pub2/full