Longitudinal trajectories of functional recovery after hip fracture

Abstract

Background There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. Methods This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. Results Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. Conclusions No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.

Associated Factors of Functional Ability in Older Persons Undergoing Hip Surgery Immediately Post-Hospital Discharge: A Prospective Study

“…Our findings differ from prior studies [26,38,39], which have indicated that comorbidities affect functional recovery. Additionally, the findings of this study revealed that severe health conditions-those with an ASA classification of 3-4-did not predict good functional ability two weeks postdischarge when compared to the other classifications, which differ from the findings of previous studies [40].…”

Impact of physiotherapy access on health-related quality of life following hip fracture: an observational study on 30 752 hip fractures from the Norwegian Hip Fracture Register 2014–2018

“… 6 Thus, it is important to optimise postoperative care to minimise the consequences of the hip fracture. 7 8 …”

Benefits of a family-based care transition program for older adults after hip fracture surgery

“…Furthermore, this condition is closely associated with multiple deficiencies in activities of daily living (ADLs), which subsequently result in loss of independence and low self-esteem. The regression in such activities subsequently results in a number of adverse outcomes, including a decline in quality of life (QoL) and an increase in admissions to nursing homes [ 3 ]. A reflection on the health-related quality of life (HRQoL) as a multidimensional concept, denoting a person’s experience of general health with regard to specific dimensions, namely, the physical, social, emotional, and functional ones [ 4 ], indicates that the lowest HRQoL seems to ensue during the first three months after hip fracture surgery (HFS) [ 5 ].…”