Functional Recovery After Hip Fracture in the Subacute Setting

Abstract

Objective

To measure functional recovery after hip fracture in the subacute setting.

Background

There are over 340,000 hip fractures that occur in the United States annually. Three out of five hospitalizations attributable to injury among persons over 75 were for fractures. Greater than 50% were hip fractures.

Purpose

The purpose of this study is to describe the functional recovery after hip fracture in the subacute setting utilizing performance-based measures (PBMs).

Method

This is a prospective observational cohort.

Data analysis

Descriptive statistics were used for baseline characteristics. Repeated measures analysis using a Bonferroni correction was utilized to compare admission and discharge PBM scores.

Results

Eighty residents were enrolled in the study, of which seven were withdrawn because of medical complications and one subject died within 1 week of admission. Data were analyzed for 72 subjects. There were 59 women and 13 men ranging in age from 63–99. Mean age was 85.3. The patients’ profiles were as follows: 53% lived alone, 63% were Medicare recipients, 50% used an assistive device before hip fracture, 46% sustained a femoral neck fracture, 57% underwent a bipolar hemiarthroplasty, 90% received epidural anesthesia, and 90% had a weight-bearing status as weight-bearing was tolerated.

The PBM results are as follows:

Mean test score of the Tinetti gait and balance, timed up and go (TUG), and 6-min walk (6MW) test, mean (SD).

  6MW (Mean sd) TUG (sec) Tinetti Gait Tinetti Balance Total Tinetti Gait/Balance
Admission (10.2 days) 63.0 (88.6) 69.5 (43.9) 2.6 (2.3) 3.5 (3.0) 5.7 (4.9)
Discharge (32.5 days) 499.2 (247.4) 32.8 (18.7) 7.2 (2.3) 9.9 (2.6) 16.8 (4.6)
p value 0.001* 0.001* 0.001* 0.001* 0.001*
  1. *Statistically significant at p < 0.05

Conclusion

There was a significant improvement between admission and discharge TUG test, Tinetti gait and balance test, and 6MW test scores in patients who underwent surgical repair of a hip fracture after a fall.

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References

  1. 1.

    Binder E, Brown M, Sinacore D, Steger-May K, Al E (2004) Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA 292(7):837–846

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Duncan PW, Weiner DK, Chandler J, Studenski S (1990) Functional reach: a new clinical measure of balance. J Gerontol 45(6):M192–M197

    PubMed  CAS  Google Scholar 

  4. 4.

    Eastwood E, Magaziner J, Wang J, Silberzweig S et al (2002) Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc 50:1240–1249

    PubMed  Article  Google Scholar 

  5. 5.

    Fox KM, Hawkes WG, Hebel JR, Felsenthal G, Clark M, Zimmerman SI, Kenzora JE, Magaziner J (1998) Mobility after hip fracture predicts health outcomes. J Am Geriatr Soc 46(2):169–173

    PubMed  CAS  Google Scholar 

  6. 6.

    Ganz S, Peterson M, Wilson P, Cioppa-Mosca J (2003) The day of discharge after total hip arthroplasty and the achievement of rehabilitation functional milestones; eleven year trends. J Arthroplast 8(4):453–457

    Article  Google Scholar 

  7. 7.

    Guccione AA, Fagerson TL, Anderson JJ (1996) Regaining Functional Independence in the acute care setting following hip fracture. Phys Ther 76(8):818–826

    PubMed  CAS  Google Scholar 

  8. 8.

    Guyatt G, Sullivan MJ, Thompson PJ et al (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132:919–923

    PubMed  CAS  Google Scholar 

  9. 9.

    Halm E, Magaziner J, Hannan E, Wang JJ, Silberzweig S, Boockvar K, Orosz GM, McLaughlin MA, Koval KJ, Siu AL (2003) Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Arch Intern Med 163(1):107–112

    Article  Google Scholar 

  10. 10.

    Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava, R (2000) Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 321(7269):1107–1111

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Ingemarsson A, Frandin K, Mellstrom D (2003) Walking ability and activity level after hip fracture in the elderly—a follow up. J Rehabil Med 35:76–83

    PubMed  Article  Google Scholar 

  12. 12.

    Jette AM, Harris BA, Cleary PD, Campion EW (1987) Functional recovery after hip fracture. Arch Phys Med Rehabil 68(10):735–740

    PubMed  CAS  Google Scholar 

  13. 13.

    Johnson MF, Kramer AM, Lin MK, Kowalsky JC, Steiner JF (2000) Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke. J Am Geriatr Soc 48(11):1389–1397

    PubMed  CAS  Google Scholar 

  14. 14.

    Kilgore KM (1995) Measuring outcomes in the postacute continuum. Arch Phys Med Rehabil 76(Suppl 12):SC21–SC26

    PubMed  CAS  Google Scholar 

  15. 15.

    Koval K, Aharonoff G, Rosenberg A, Bernstein R, Zuckerman J (1998) Functional outcome after hip fracture. Clin Orthop Relat Res 348:37–41

    PubMed  Google Scholar 

  16. 16.

    Koval KJ, Zuckerman JD (1994) Functional recovery after fracture of the hip. J Bone Joint Surg Am 76(5):751–758

    PubMed  CAS  Google Scholar 

  17. 17.

    Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD (1995) Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop (310):150–159

  18. 18.

    Kroll M, Ganz S, Backus S, Benick R, MacKenzie C, Harris L (1994) A tool for measuring functional outcomes after total hip arthroplasty. Arthritis Care Res 7(2):78–84

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Laskin RS, Gruber MA, Zimmerman AJ (1979) Intertrochanteric fractures of the hip in the elderly: a retrospective analysis of 236 cases. Clin Orthop Relat Res 141:188–195 (Jun)

    PubMed  Google Scholar 

  20. 20.

    Lyons AR (1997) Clinical outcomes and treatment of hip fractures. Am J Med 103(2A):51S–59S

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Magaziner J, Simonsick E, Kashner T et al (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278

    PubMed  CAS  Google Scholar 

  22. 22.

    Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45(3):M101–M107

    PubMed  CAS  Google Scholar 

  23. 23.

    Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55(9):M498–M507

    PubMed  CAS  Google Scholar 

  24. 24.

    Michel JP, Hoffmeyer P, Klopfenstein C, Bruchez M, Grab B, d’Epinay CL (2000) Prognosis of functional recovery 1 year after hip fracture: typical patient profiles through cluster analysis. J Gerontol A Biol Sci Med Sci 55(9):M508–M515

    PubMed  CAS  Google Scholar 

  25. 25.

    Morris A, Zuckerman J (2001) National consensus conference on improving the continuum of care for patients with hip fracture. JBJS, Washington, DC, pp 670–674 (edited, 670–674)

    Google Scholar 

  26. 26.

    Mossey JM, Mutran E, Knott K, Craik R (1989) Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health 79(3):279–286

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148

    PubMed  CAS  Google Scholar 

  28. 28.

    Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34(2):119–126

    PubMed  CAS  Google Scholar 

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Correspondence to Sandy B. Ganz PT, DSc, GCS.

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Ganz, S.B., Peterson, M.G., Russo, P.W. et al. Functional Recovery After Hip Fracture in the Subacute Setting. HSS Jrnl 3, 50–57 (2007). https://doi.org/10.1007/s11420-006-9022-3

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Key words

  • performance-based measure
  • hip fractures
  • Tinetti gait and balance
  • timed up and go
  • 6MW test