Recovery of health-related quality of life in a United Kingdom hip fracture population

Griffin, Xavier L; Parsons, Nicholas R.; Achten, Juul; Fernandez, Miguel; Costa, Matthew L.

doi:10.1302/0301-620x.97b3.35738

Cited by 174 publications

(140 citation statements)

References 15 publications

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“…In Swedish and Japanese studies, the proportion of surviving patients walking was found to be similar at 4 months and 1 to 2 years [31, 34, 45] and in community living people the proportion of survivors walking remained relatively constant to 10 years [31]. In contrast, a UK study found some increase in the proportion walking at 1 year [46]. …”

Section: Resultsmentioning

confidence: 99%

A critical review of the long-term disability outcomes following hip fracture

et al. 2016

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Background: Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. This review aims to quantify the impact of hip fracture on older people's abilities and quality of life over the long term. Methods: Studies were identified through PubMed and Scopus searches and contact with experts. Cohort studies of hip fracture patients reporting outcomes 3 months post-fracture or longer were included for review. Outcomes of mobility, participation in domestic and community activities, health, accommodation or quality of life were categorised according to the World Health Organization's International Classification of Functioning and synthesised narratively. Risk of bias was assessed according to four items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results: Thirty-eight studies from 42 publications were included for review. Most followed a clearly defined sample from the time of fracture. Hip fracture survivors experienced significantly worse mobility, independence in function, health, quality of life and higher rates of institutionalisation than age matched controls. The bulk of recovery of walking ability and activities for daily living occurred within 6 months after fracture. Between 40 and 60 % of study participants recovered their pre-fracture level of mobility and ability to perform instrumental activities of daily living, while 40-70 % regained their level of independence for basic activities of daily living. For people independent in self-care pre-fracture, 20-60 % required assistance for various tasks 1 and 2 years after fracture. Fewer people living in residential care recovered their level of function than those living in the community. In Western nations, 10-20 % of hip fracture patients are institutionalised following fracture. Few studies reported impact on participation in domestic, community, social and civic life.

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Section: Resultsmentioning

confidence: 99%

A critical review of the long-term disability outcomes following hip fracture

et al. 2016

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“…The current annual hospital cost of hip fractures in the UK has been estimated at £1.1 billion (Leal et al, 2016). Thus, it is vital to further improve fracture prevention strategies, not only to decrease health care costs, but also to reduce devastating outcomes such as morbidity, disability, dependency, and poor quality of life (Griffin et al, 2015;Parker, 2016). Many, often modifiable, risk factors need to be considered for hip fracture prevention.…”

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confidence: 99%

The association between decreased hand grip strength and hip fracture in older people: A systematic review

Denk

Lennon

Gordon

et al. 2018

Experimental Gerontology

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The association between decreased hand grip strength and hip fracture in older people: a systematic review ABSTRACT Hip fractures are a global concern, resulting in poor outcomes and high health care costs. They mostly affect people >80 years. Hip fractures are influenced by various (modifiable) risk factors. Emerging evidence suggests hand grip strength (HGS) to be one of several useful tools to identify hip fracture risk. This is the first systematic review that aims to assess the evidence underlying the relationship between hip fracture incidence and HGS. Eleven studies were selected for this review (six case-control and five cohort studies), comprising 21197 participants. Where reported, HGS was significantly decreased in individuals with a hip fracture near the time of injury as compared to controls (p<0.001); HGS was associated with increased hip fracture risk in all included studies. Meta-analysis was not possible. All studies included in this systematic review confirmed a relationship between decreased HGS and hip fracture incidence. We were not able to quantify the strength of this relationship, due to the heterogeneity of the included studies. HGS merits further investigation as a useful tool for identifying individuals that might be at elevated risk for sustaining a hip fracture. Key words: Hand grip strength, hip fracture, proximal femur fracture, frailty, risk factor 1. Introduction Low impact fractures of the proximal femur (hip fractures) are a major worldwide public health concern (Hernlund et al., 2013; Kanis et al., 2012; The World Bank, 2015). They mostly occur in people older than 80 years (Kistler et al., 2015). As the population ages, hip fractures are predicted to increase by 35% between 2012 and 2022; the annual cost will rise to $1.27 billion in Australia alone (Watts et al., 2013). The current annual hospital cost of hip fractures in the UK has been estimated at £1.1 billion (Leal et al., 2016). Thus, it is vital to further improve fracture prevention strategies, not only to decrease health care costs, but also to reduce devastating outcomes such as morbidity, disability, dependency, and poor quality of life (Griffin et al., 2015;Parker, 2016). Many, often modifiable, risk factors need to be considered for hip fracture prevention. Osteoporosis (Kanis, 1994) and falls (Jarvinen et al., 2008) are recognized risk factors for sustaining a hip fracture. Other factors include, but are not limited to, sarcopenia (Oliveira and Vaz, 2015), muscle weakness, physical inactivity, impaired cognition, impaired vision, and chronic health conditions (Marks, 2010). The current gold standard screening tool to assist in identifying those most at risk of hip fracture is the Fracture Risk Assessment Tool (FRAX®). FRAX is based on 12 variables: age, sex, weight, height, previous fracture, parent fractured hip, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol (three or more units/day), and femoral neck bone mineral density (BMD) (The University of Sheffield, 2011). Lo...

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“…While overall health indicators such as the EQ-5D have been accepted as reasonable compromises in that they can capture an adequate amount of information on these sometimes parlous health states and have adequate validity when completed by relatives or carers [13], the ultimate question in hip fracture care is whether we are restoring pre-injury function to these patients. This has been qualitatively demonstrated to be patients' greatest concern when considering hip fracture [14] and clear effects have been shown in recent output from the Warwick Hip Trauma Evaluation (WHiTE) study [15,16]. As this data is sourced locally rather than from national datasets, there is a possibility that patients who have experienced complications from their surgery have presented elsewhere and this episode has not been captured.…”

Section: Discussionmentioning

confidence: 99%

“…It has recently been demonstrated that these patients lose a significant quality of life permanently and, early in their recovery, a proportion rate their state of health as worse than being dead [3]. While care has advanced substantially in recent years, there remains a significant burden of mortality associated with the injury [4].…”

Section: Introductionmentioning

confidence: 99%

Changing trends in the management of intertrochanteric hip fractures – A single centre experience

Page

Lord

Jawad

et al. 2016

Injury

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With an annual incidence greater than 65,000 in the United Kingdom, hip fractures are a common but debilitating injury predominantly affecting those over 65. Treatment is based on the anatomical location of the fracture relative to the capsule of the hip joint - fractures occurring within it are treated by arthroplasty, while extracapsular fractures are an indication for fixation. Intertrochanteric fractures are further grouped as stable (AO/OTA 31A1/A2) or unstable (31A3) which in turn governs in the current UK guidelines whether this fixation is achieved with a dynamic hip screw or intramedullary device. Anecdotally, some units are tending towards intramedullary devices for 31A2 fractures as well, a practice which from the evidence does not appear to confer benefit and carries an excess cost. We reviewed our data submitted to the National Hip Fracture Database over the last five years and identified all intertrochanteric fractures, from which cohort we identified all patients with 31A2 fractures by review of radiographs. The cohort comprised 370 patients. We then recorded age, gender, ASA grade, abbreviated mental test score, residence from where admitted, length of stay, destination on discharge and whether any further operations were required. There was no significant difference in the demographics of the groups, year-on-year, except gender mix. There was a significant, twenty-fold rise in the use of intramedullary devices between 2011 and 2015. Length of stay, length of overall episode of care, revision rates, mortality and destination on discharge were unchanged. This use is not supported by NICE guidelines and this study offers no evidence to contradict this position. We advocate all centres examine their practice to avoid a costly intervention without clinical benefit.

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Recovery of health-related quality of life in a United Kingdom hip fracture population

Cited by 174 publications

References 15 publications

A critical review of the long-term disability outcomes following hip fracture

A critical review of the long-term disability outcomes following hip fracture

The association between decreased hand grip strength and hip fracture in older people: A systematic review

Changing trends in the management of intertrochanteric hip fractures – A single centre experience

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