Physical Functioning in Patients with a Recent Fracture: The “Can Do, Do Do” Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors

Abstract

Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the “can do, do do” framework. We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can’t do/can do) and PA by accelerometer (don’t do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) “can’t do, don’t do”; (2) “can do, don’t do”; (3) “can’t do, do do”; (4) “can do, do do”. Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% “can’t do, don’t do”; 3.0% “can do, don’t do”; 19.3% “can’t do, do do”; 69.5% “can do, do do”. For the “can’t do” group the OR for low PA was 9.76 (95% CI: 4.82–19.80). Both the “can’t do, don’t do” and “can’t do, do do” group differed significantly compared to the “can do, do do” group on several fall and fracture risk factors and had lower physical performance. The “can do, do do” framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% “can’t do, but “do do” while having a high prevalence of fall risk factors compared to persons that “can do, do do”, which may indicate this group is prone to fall.

The “Can Do, Do Do” Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service

“…The "can do, do do" framework and our methods of testing PC and PA have been previously described elsewhere in detail [15]. In short, the framework combines a measure of PC with a measure of PA to form four quadrant groups: 1. preserved PC, preserved PA (can do, do do); 2. low PC, preserved PA (can't do, do do); 3. preserved PC, low PA (can do, don't do); 4. low PC, low PA (can't do, don't do).…”

“…PA was measured during eight consecutive days in which patients were asked to follow normal daily activity routines. Details on the properties, processing of data, activity classification, calibration, and validity are described in detail elsewhere [15,37,38]. Static and dynamic activity (DA) were determined using the signal magnitude area: a measure of the intensity of physical activity.…”

“…It combines two distinct, yet related, domains of physical performance: physical capacity (PC; can do, can't do) and physical activity (PA; do, do, don't do) into four quadrant groups [13,14]. PC is objectively measured physical performance; in the "can do, do do" framework, the 6 min walking test (6MWT) is used to test walking ability [13,15]. Impaired walking ability (e.g., abnormalities in gait or balance) has been associated with future falls [12,[16][17][18][19] and fractures and post-fracture mortality (in males) [20,21].…”

“…In fact, some studies found a U-shaped association with both inactive and highly active adults at increased fall risk [26]. The "can do, do do" framework has proven to be a useful and practical tool to identify patient subgroups with distinct clinical characteristics [13,15,27,28]. In patients with COPD, a preserved PC was found to be associated with a lower 6-year mortality risk compared to decreased PC, regardless of PA level [29].…”

“…In patients with COPD, a preserved PC was found to be associated with a lower 6-year mortality risk compared to decreased PC, regardless of PA level [29]. A recent study in patients with a fracture showed that the framework was able to categorize patient groups in terms of fall and fracture risk factors, such as fall history, fear of falling, type of fracture, and osteoporosis [15]. Thus, for fracture patients the "can do, do do" framework could possibly be of value to test physical performance in the context of future falls in order to guide personalized exercise interventions.…”