Trajectories and prognostic factors for recovery after hip fracture: a longitudinal cohort study

Munter, Leonie de; Ree, Cornelis L. P. van de; Jagt, Olav P. van der; Gosens, Taco; Maas, Huub; Jongh, Mariska A. C. de

doi:10.1007/s00264-022-05561-4

Cited by 6 publications

(5 citation statements)

References 38 publications

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“…29 A Dutch study reported that prefracture loneliness was associated with a worse recovery and increased anxiety and depression after hip fracture. 30 However, in that study, 27% of participants had dementia, a strong predictor of poor outcomes. This study showed that among relatively high functioning, cognitively intact individuals, prefracture loneliness was associated with clinically meaningfully worse anxiety, pain, depression, sleep, and physical function 1 year later.…”

Section: Discussionmentioning

confidence: 71%

The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low Energy Hip Fracture

Mandl,

Rajan,

Lipschultz

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To evaluate if social isolation or loneliness is associated with outcomes 1 year after low energy hip fracture. METHODS: Design: Prospective inception cohort study. Setting: Academic Level I Trauma Center. Patient Selection Criteria: Participants were ≥ 65 years of age and enrolled 2-4 days after surgery for a first low energy hip fracture. Exclusion criteria were bilateral or periprosthetic hip fracture, previous hip fracture, non-English speaking, international address, active cancer, stage 4 cancer in the past 5 years, radiation to the hip region and cognitive impairment. Participants were followed longitudinally for one year. Outcome Measures and Comparisons: The PROMIS-29 was elicited 2-4 days post-operatively and 1 year later. Patient reported risk factors included the Lubben Social Networks Scale and the UCLA Loneliness Scale, which were compared to the Lower Extremity Activity Scale and PROMIS-29 domains. RESULTS: Three hundred and twenty-five patients were enrolled. Participants had a median age of 81.7 years, were 70.9 % female and were 85.9% white. 31.6% of patients were socially isolated at time of fracture. At 1 year, 222 of the 291 subjects who were confirmed alive at one year provided data. Multivariable linear models were performed separately for each outcome, including Lower Extremity Activity Scale and PROMIS-29 domains. Controlling for age, sex, education, and body mass index, those who were socially isolated at time of fracture had worse PROMIS-29 function (β= -3.83 p= 0.02) and ability to participate in social roles (β= -4.17 p= 0.01) at 1 year. Secondary analyses found that pre-fracture loneliness was associated with clinically meaningfully worse function, anxiety, depression, fatigue, sleep, pain and ability to participate in social roles at 1 year, (all p< 0.01). CONCLUSIONS: Pre-fracture social isolation was associated with worse outcomes 1 year after surgical repair of low energy hip fracture. This data suggests loneliness may be more strongly associated with important patient centric metrics than pre-fracture social isolation. Given the dearth of modifiable risk factors in this population, future studies are needed to evaluate whether improving social connections could impact outcomes in this rapidly growing demographic.

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Section: Discussionmentioning

confidence: 71%

The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low Energy Hip Fracture

Mandl,

Rajan,

Lipschultz

et al. 2024

Journal of Orthopaedic Trauma

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“…Moreover, the patients with hip fracture often have medical frailty, which is connected to several comorbidities, resulting in vulnerability and reduced ability to recover from a stressor event. De Munter et al (2022) found that frailty was associated with poor recovery, including walking ability [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…They concluded that walking speed could predict long-term functional changes and clinical outcomes, such as institutionalization and death [ 23 ]. However, such objective performance-based outcome measures in the early acute phase may be demanding for the older patients who also may have medical frailty [ 21 , 24 ]. Our experience is that some are unable to perform the tests.…”

Section: Introductionmentioning

confidence: 99%

Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity

Heiberg,

Beckmann,

Bruun-Olsen

2024

BMC Geriatr

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Background Older people with hip fracture are often medically frail, and many do not regain their walking ability and level of physical activity. The aim of this study was to examine the relationship between pre-fracture recalled mobility, fear of falling, physical activity, walking habits and walking speed one year after hip fracture. Methods The study had a longitudinal design. Measurements were performed 3–5 days postoperatively (baseline) and at one year after the hip fracture. The measurements at baseline were all subjective outcome measures recalled from pre-fracture: The New Mobility Scale (NMS), the ‘Walking Habits’ questionnaire, The University of California, Los Angeles (UCLA) Activity Scale, Fear of Falling International (FES-I) and demographic variables. At one year 4-meter walking speed, which was a part of the Short Physical Performance Battery (SPPB) was assessed. Results At baseline 207 participants were included and 151 were assessed after one year. Their age was mean (SD) 82.7 (8.3) years (range 65–99 years). Those with the fastest walking speed at one year had a pre-fracture habit of regular walks with a duration of ≥ 30 min and/or a frequency of regular walks of 5–7 days a week. Age (p =.020), number of comorbidities (p <.001), recalled NMS (p <.001), and recalled UCLA Activity Scale (p =.007) were identified as predictors of walking speed at one year. The total model explained 54% of the variance in walking speed. Conclusions Duration and frequency of regular walks before the hip fracture play a role in walking speed recovery one year following the fracture. Subjective outcome measures of mobility and physical activity, recalled from pre-fracture can predict walking speed at one year. They are gentle on the old and medically frail patients in the acute phase after hip fracture, as well as clinically less time consuming.

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“…Several studies aiming at identifying groups following distinct trajectories of function after hip fracture have been published in recent years [ 19 – 21 ]. One such study aimed to identify different groups following distinct trajectories of recovery, and found that frail hip fracture patients were more likely to belong to a trajectory with worse recovery compared to non-frail hip fracture patients, and that poor recovery was associated with dementia [ 22 ]. Identifying such groups and patient characteristics associated with these, may be useful in determining rehabilitation potential and targeting treatment to each patient.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal trajectories of functional recovery after hip fracture

et al. 2023

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Background There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. Methods This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. Results Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. Conclusions No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.

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Trajectories and prognostic factors for recovery after hip fracture: a longitudinal cohort study

Cited by 6 publications

References 38 publications

The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low Energy Hip Fracture

The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low Energy Hip Fracture

Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity

Longitudinal trajectories of functional recovery after hip fracture

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