The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

Abstract

Introduction Due to the aging population the incidence of Low Energy Fractures (LEF) increases. LEF have high mortality and morbidity rates and often cause elderly to lose independence. Patient-reported outcomes, such as Quality of Life (QoL) and patient satisfaction (PS) are needed to evaluate treatment, estimate cost-benefit analyses, and to improve clinical decision-making and patient-centered care. Objective The primary goal was to evaluate QoL and PS in patients with LEF, and to compare QoL scores to the community dwelling population. Second, we observed the amount and type of physiotherapy (PT) sessions the patients conducted. Methods A single-center cohort study was conducted in Switzerland. Patients between 50 and 85 years, who were treated in the hospital for LEF, were followed 1 year after initial fracture. Data on QoL were obtained through the Euroqol-5-Dimension questionnaire-3-Level (EQ-5D-3L) and the EQ VAS (visual analog scale). PS was measured by a VAS on satisfaction with treatment outcome. Data on PT sessions, mobility and use of analgesics were collected by telephone interviews and written surveys. Results were compared between the different fracture locations and subgroup analyses were performed for age categories. Results 411 patients were included for analysis. The median scores of the EQ-5D-3L index—VAS and PS were 0.90 (0.75–1.0), 90 (71.3–95) and 100 (90–100). Significant differences in all scores were found between fracture location ( P < .05), with hip fracture patients and patients with a malleolar fracture scoring lowest in all measures. QoL index in hip fracture patients was 0.76 (0.70–1.00), QoL VAS 80 (70–90), and PS 95 (80–100). Median amount of PT sessions in all patients was 18 (9–27) and a significant difference was found between fracture locations. Patients with a fracture of the humerus received the highest amount of PT sessions 27 (18–36), hip fracture patients had a median of 18 (9–27) sessions. Conclusion At follow-up, QoL throughout all patients with a LEF was comparable to a normal population. Remarkably, though hip fracture patients seem to suffer from a clinically relevant loss of QoL, they received fewer PT sessions and performed fewer long-lasting home training than patients with a humerus fracture. Intensive, progressive rehabilitation with a high frequency of supervised training is recommended after hip fracture. The low frequency of PT sessions found in this study is unsatisfying. In hip fracture patients and in patients with a malleolar fracture, especially when aged over 75 years, more efforts are required to improve rehabilitation and subsequently QoL.

Three-year outcomes of a fracture liaison service model at a university-based tertiary care hospital in Thailand

“…For instance, Chiang et al [ 22 ] and Imai et al [ 23 ] reported mean BI scores of 71.1 and 71.9 points at 1- and 2-year post-hip fracture treatment, respectively. Similarly, our mean 1-year EQ-VAS score (77.0 ± 17.5) is comparable to the mean of 67 ± 2 reported by Svedbom et al [ 24 ] and the mean of 80 ± 10 found by van der Vet et al [ 25 ]…”

“…For instance, Chiang et al [22] and Imai et al [23] reported mean BI scores of 71.1 and 71.9 points at 1-and 2-year post-hip fracture treatment, respectively. Similarly, our mean 1-year EQ-VAS score (77.0 ± 17.5) is comparable to the mean of 67 ± 2 reported by Svedbom et al [24] and the mean of 80 ± 10 found by van der Vet et al [25] Our 1-and 3-year mortality rates were 13.9% and 20.4%, respectively. These numbers were compatible with those reported in a previous systematic review and meta-analysis of various centers with an FLS care model [8,19].…”

Quality and reporting of patient-reported outcomes in elderly patients with hip fracture: a systematic review

“…Earlier literature on PROs in elderly patients with a hip fracture shows that a hip fracture negatively affects PROs such as Quality of Life (QoL), and that Fear of Falling is increased after a hip fracture, thereby increasing the risk of a secondary fracture 7. PROs are frequently used in recent hip fracture studies researching different types of treatment, or studies investigating the potential benefit of comanaged care pathways (ie, orthogeriatric care pathways) 8 9…”