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Toward a Meaningful Definition of Recovery After Hip Fracture: Comparing Two Definitions for Community-Dwelling Older Adults

Published:February 15, 2018DOI:https://doi.org/10.1016/j.apmr.2018.01.022

      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)
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