Prognostic Factors for Short-term Recovery of Independence in a Multistate Model for Patients With a Hip Fracture

Abstract

Objectives: This study investigates the transitions of community-dwelling patients with a proximal femoral fracture towards recovery of independence using multistate modeling. The prognostic value of factors affecting the short-term rate of recovery of independence in activities of daily living was assessed for the resilient portion of the population. Design: An inception cohort was recruited between 2016 and 2019. Setting and Participants: Only community-dwelling older patients admitted with a proximal femoral fracture were included. Measures: Follow-up was performed at 6 weeks and 3 months, when the patients' living situation and level of independence were recorded. Multistate modeling was used to study the transition rates of the population through prespecified states of the recovery process. Using this model, prognostic factors for the recovery of independence were identified for resilient patients (defined as those patients who managed to return home at any point in the follow-up after discharge). Results: A total of 558 patients were included, and 218 (40.9%) recovered to prefracture levels of independence. Of the resilient patients, 20.7% were discharged home directly, and 79.3% via a rehabilitation home. In this patient group, a more favorable American Society of Anesthesiologists classification, better prefracture mobility, and the absence of a prefracture fear of falling were statistically significantly associated with a successful recovery. A low level of prefracture independence was inversely associated, meaning that patients with a low level of prefracture independence had a higher chance of successful recovery. Conclusions and Implications: This study identified 4 factors with an independent prognostic value for the recovery of independence in resilient patients after a proximal femoral fracture. These factors could be used to construct clinical profiles that contribute to the assessment of the patient's post-acute care needs and recovery capacity. In addition, multistate modeling has been shown to be an effective and versatile tool in the study of recovery prognostics.

Course of fear of falling after hip fracture: findings from a 12-month inception cohort

“…At present, there is no comparative literature on this topic, although one previous study provides evidence that prefracture FoF affects short-term functional recovery. 12 Our findings illustrate that, contrary to those without prefracture FoF, patients with prefracture FoF have sustained elevated FES-I levels over time. The mean FES-I score for the group with prefracture FoF is approximately 2 points higher compared with the group without prefacture FoF.…”

“…However, the absence of prefracture FoF has been associated with successful short-term functional recovery, which points towards an important role for prefracture FoF in the recovery process. 12 Although the mechanism for this effect remains to be determined, we expect that prefracture FoF has the potential to affect the course of FoF after fracture, and could therefore affect functional outcome. For this purpose, we will explore FoF trajectories based on the presence/absence of FoF prior to fracture.…”

“…[9][10][11] This includes fear of falling (FoF), defined as 'a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing'. [12][13][14][15] Considering that FoF is common following hip fracture and has been found to impede functional recovery after fracture, this may be a meaningful factor to address in order to improve the recovery process. 13 14 16 17 Although various effective treatment programmes are available for communitydwelling older adults, studies evaluating treatment of FoF for patients with hip fracture are scarce, and their findings inconclusive.…”

Geriatric rehabilitation care after hip fracture

“…The data we collected were derived from the Inventarisation of Prognostic factors and their Contribution towArds REhabilitation in older persons study (HIPCARE). HIPCARE is an inception cohort-based study, initiated in 2018 and still ongoing, of patients with hip fractures admitted to the acute care at Haaglanden Medical Centre (HMC +) in the Hague [ 3 ]. We included previously community-dwelling patients aged 70 years or older with a unilateral hip fracture and who were eligible for (inpatient) geriatric rehabilitation.…”

“…The prognosis of patients with hip fractures is a major concern because the 1-year mortality rate is 20% [ 1 , 2 ]. In addition, 60–80% of these patients do not reach their pre-morbid independence, and approximately, 20% of them are permanently institutionalized [ 3 ]. This leads to great personal, financial, and societal burden [ 4 ].…”