Abstract
Objective
To identify the factors associated with recovering autonomy in activities of daily
living (ADL) in patients who have had a hip fracture.
Design
A prospective cohort study.
Setting
The orthopedic and orthogeriatric departments of 2 regional hospitals.
Participants
Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture.
Main Outcome Measures
The level of autonomy at 4 months was assessed using the ADL scale.
Results
The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half
of the population was unable to recover their prefracture autonomy levels. The following
were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014).
Conclusions
Recovery of deambulation, treatment of disorientation and management of incontinence
are modifiable factors significantly associated with the functional recovery of autonomy.
Keywords
List of abbreviations:
ADL (activities of daily living), IQR (interquartile range)To read this article in full you will need to make a payment
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References
- Estimating the long-term functional burden of osteoporosis-related fractures.Osteoporos Int. 2017; 28: 2843-2851
- Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation—a prospective cohort study.Bone Joint J. 2015; 97-B: 372-382
- Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients.Bone. 2012; 50: 1343-1350
- Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up.J Rehabil Med. 2007; 39: 232-238
- Does standardized rehabilitation and discharge planning improve functional recovery in elderly patients with hip fracture?.Arch Phys Med Rehabil. 2005; 86: 2231-2239
- More than half of hip fracture patients do not regain mobility in the first postoperative year.Geriatr Gerontol Int. 2013; 13: 334-341
- National Health and Medical Research Council. Evidence-based guidelines for the management of hip fractures in older persons: an update.Med J Aust. 2010; 192: 37-41
- Comprehensive geriatric care for patients with hip fractures: a prospective, randomized, controlled trial.Lancet. 2015; 385: 1623-1633
- The effect of care pathways for hip fractures: a systematic overview of secondary studies.Eur J Orthop Surg Traumatol. 2013; 23: 737-745
- Comprehensive geriatric assessment for older adults admitted to hospital.Cochrane Database Syst Rev. 2011; : CD006211
- Optimal setting and care organization in the management of older adults with hip fracture.Eur J Phys Rehabil Med. 2011; 47: 281-296
- Ortho-geriatric service a literature review comparing different models.Osteoporos Int. 2010; 21: S637-S646
- Early ambulation after hip fracture: effects on function and mortality.Arch Intern Med. 2006; 166: 766-771
- Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture.Arch Phys Med Rehabil. 2007; 88: 916-921
- Recovery of walking ability and return to community living within 60 days of hip fracture does not differ between male and female survivors.J Am Geriatr Soc. 2015; 63: 1640-1644
- Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture.Geriatr Gerontol Int. 2015; 15: 289-295
- Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture—a population-based study.Arch Gerontol Geriatr. 2015; 61: 182-189
- Factors affecting functional prognosis of patients with hip fracture.Eur J Phys Rehabil Med. 2011; 47: 257-264
- Functioning and health-related quality of life following injury in older people: a systematic review.Inj Prev. 2017; 23: 403-417
- A critical review of the long-term disability outcomes following hip fracture.BMC Geriatr. 2016; 16: 158
- Effects of using consumer and expert ratings of an activities of daily living scale on predicting functional outcomes of postacute care.J Clin Epidemiol. 2001; 54: 334-342
- Municipality-based physical rehabilitation after acute hip fracture surgery in Denmark.Dan Med J. 2015; 62: A5023
- Routine functional assessment for hip fracture patients.Acta Orthop. 2016; 87: 374-379
- The deleterious effects of bed rest among community-living older persons.J Gerontol A Biol Sci Med Sci. 2004; 59: 755-761
- Intramedullary nails for extracapsular hip fractures in adults.Cochrane Database Syst Rev. 2014; : CD004961
- Guideline Development Group. Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance.BMJ. 2014; 348: g2592
- Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes.J Adv Nurs. 2015; 71: 1464-1483
- Extended exercise rehabilitation after hip fracture improves patients' physical function: a systematic review and meta-analysis.Phys Ther. 2012; 92: 1437-1451
- Does functional recovery in elderly hip fracture patients differ between patients admitted from long-term care and the community?.J Gerontol A Biol Sci Med Sci. 2007; 62: 1127-1133
- When should we operate on elderly patients with a hip fracture? It's about time!.Surgeon. 2012; 10: 185-188
- Early and ultra-early surgery in hip fracture patients improves survival.Injury. 2013; 44: 726-729
- Early mortality after hip fracture: is delay before surgery important?.J Bone Joint Surg Am. 2005; 87: 483-489
- Association of timing of surgery for hip fracture and patient outcomes.JAMA. 2004; 291: 1738-1743
- Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture.BMC Res Notes. 2012; 5: 355
Article info
Publication history
Published online: February 10, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
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- CorrectionArchives of Physical Medicine and RehabilitationVol. 101Issue 3
- PreviewIn the article by Morri et al, What Factors Are Associated With the Recovery of Autonomy After a Hip Fracture? A Prospective, Multicentric Cohort Study, published in Archives of Physical Medicine and Rehabilitation 2018;99:893-899 ( https://doi.org/10.1016/j.apmr.2018.01.021 ), an author’s name was misspelled. The seventh author’s name should have been spelled Lorenzo Marcato.
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