Proximal femoral fractures in the elderly: How are we measuring outcome?

Hutchings, Lynn; Fox, Rebecca; Chesser, Tim

doi:10.1016/j.injury.2010.12.016

Cited by 62 publications

(53 citation statements)

References 138 publications

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“…6 However, the measurement properties of EQ-5D have been widely studied more generally. 22-24 EQ-5D also facilitates the generation of health utility.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 In many areas of healthcare, PROMs specific to a particular disease or area of the body are considered the most sensitive to changes in outcome. However, patients who suffer fragility fracture of the hip represent a highly heterogeneous population; ranging from extremely frail to fit and active patients, with and without serious comorbidities or cognitive impairment, sometimes with pre-existing deterioration in health-related quality of life (HRQOL).…”

Section: Introductionmentioning

confidence: 99%

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Outcome assessment after hip fracture

Parsons

Griffin

Achten

et al. 2014

Bone & Joint Research

112

100

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ObjectivesTo study the measurement properties of a joint specific patient reported outcome measure, a measure of capability and a general health-related quality of life (HRQOL) tool in a large cohort of patients with a hip fracture.MethodsResponsiveness and associations between the Oxford Hip Score (a hip specific measure: OHS), ICEpop CAPability (a measure of capability in older people: ICECAP-O) and EuroQol EQ-5D (general health-related quality of life measure: EQ-5D) were assessed using data available from two large prospective studies. The three outcome measures were assessed concurrently at a number of fixed follow-up time-points in a consecutive sequence of patients, allowing direct assessment of change from baseline, inter-measure associations and validity using a range of statistical methods.ResultsICECAP-O was not responsive to change. EQ-5D was responsive to change from baseline, with an estimated standardised effect size for the two datasets of 0.676 and 0.644 at six weeks and four weeks respectively; this was almost as responsive to change as OHS (1.14 at four weeks). EQ-5D correlated strongly with OHS; Pearson correlation coefficients were 0.74, 0.77 and 0.70 at baseline, four weeks and four months. EQ-5D is a moderately good predictor of death at 12 months following hip fracture. Furthermore, EQ-5D reported by proxies (relatives and carers) behaves similarly to self-reported scores.ConclusionsOur findings suggest that a general HRQOL tool such as EQ-5D could be used to measure outcome for patients recovering from hip fracture, including those with cognitive impairment.Cite this article: Bone Joint Res 2014;3:69–75.

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“…6 However, the measurement properties of EQ-5D have been widely studied more generally. 22-24 EQ-5D also facilitates the generation of health utility.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome assessment after hip fracture

Parsons

Griffin

Achten

et al. 2014

Bone & Joint Research

112

100

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“…Functional status was evaluated by the Barthel index score. 15,16 Among the 35 control pairs (70 patients), 62 patients were assessed at the last outpatient department visit, six patients by phone interview and two patients by mail.…”

Section: Methodsmentioning

confidence: 99%

Concomitant hip and distal radius fractures

Lin

Hung

et al. 2015

Journal of the Chinese Medical Association

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“…This was recognised as a limitation of traditional review methods, as were the myriad of treatment strategies used and inconsistent reporting, 9,10,23,24,47,50 which made comparisons across studies difficult and led to inconclusive results. 3,[8][9][10]21,[23][24][25]28,29,47,49,50,240,241 These issues also led to difficulties in replicating intervention designs in different health-care systems as well as in drawing evidence-based conclusions about best practice. 10,24 Successfully combining a few commonly reported outcomes to estimate the long-term health outcomes of rehabilitation programmes 10 could help to more accurately estimate the comorbid disease burden, which may benefit from longer-term rehabilitation and falls prevention programmes, leading to health gains and reduced costs in the long term.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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Proximal femoral fractures in the elderly: How are we measuring outcome?

Cited by 62 publications

References 138 publications

Outcome assessment after hip fracture

Outcome assessment after hip fracture

Concomitant hip and distal radius fractures

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

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