Highlights
- •We should rethink the definition of recovery after hip fractures in research and clinical practice.
- •A standardized definition of recovery can improve our understanding of the recovery process and help take clinical decisions.
- •The ability to climb stairs can be used as an indicator of physical functional recovery after hip fracture.
- •Climbing stairs reflects functional reserve and is strongly associated with patients’ quality of life.
Abstract
Objectives
To examine the course of recovery and resulting health-related quality of life (HRQL)
after low-trauma hip fracture using 2 different definitions of recovery.
Design
Inception cohort with 8 assessments over 1 year.
Setting
Participants were recruited from a tertiary-care hospital and followed up in the community.
Participants
Community-dwelling hip fracture patients (N=47, 75% of all eligible; aged ≥65y).
Interventions
Not applicable.
Main Outcome Measures
Prefracture functional level was used to identify subgroups of participants with similar
trajectories of mobility over time. Recovery in functional mobility was defined in
2 ways: the “traditional” definition (return to prefracture level of functional mobility)
and a “targeted recovery” definition (ability to climb 10 steps). Both were measured
using the Lower Extremity Functional Scale. HRQL was measured using the RAND 36-Item
Short-Form Health Survey.
Results
Participants were categorized into 3 subgroups with: low, medium, and high prefracture
functional abilities. Agreement between the 2 definitions of recovery (quantified
using κ coefficient) was strong for the medium group (.81; 95% confidence interval,
.56–1.00), weak for the high group (.46; 95% confidence interval, 0.0–.99), and minimal
for the low group (.12; 95% confidence interval, 0.0–.328). Contrary to the traditional
definition, patients who achieved targeted recovery had statistically and clinically
better HRQL than the rest of the cohort throughout the study (estimated average difference
of 10.8 points on RAND 36-Item Short-Form Health Survey; 95% confidence interval,
6.67–15.07).
Conclusions
The agreement between the 2 definitions of recovery ranged from minimal to strong
according to patient group. Using a functional target to define recovery predicted
HRQL better. It is vital to consider the definition of recovery carefully for research
or clinical practice because it can influence subsequent decisions (eg, endorsing
a specific intervention or discharging patients).
Keywords
List of abbreviations:
GEE (generalized estimating equation), HRQL (health-related quality of life), LEFS (Lower Extremity Functional Scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 15, 2018
Footnotes
Supported by the Helen McCall Hutchison Scholarship and the McGill University Health Centre (MUHC) Research Institute Pilot Project Competition 2008.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
