The association between hand grip strength and rehabilitation outcome in post-acute hip fractured patients

Successful Rehabilitation After Surgical Repair of Hip Fracture Has Been Associated With Handgrip Strength But Not With Orthostatic Hypotension in Patients 65 Yrs of Age and Above

OBJECTIVE

The identification of factors associated with successful rehabilitation after hip fractures enables more successful planning of the rehabilitation process and discharge from the hospital. Orthostatic hypotension and handgrip strength have been evaluated in previous studies as potential predictors of rehabilitation outcomes, with inconsistent results.

DESIGN

A retrospective study of patients 65 yrs of age and above who underwent rehabilitation after surgical repair of hip fracture in the geriatric department between July 2020 and October 2023. Handgrip strength was measured during the first 3 days of hospitalization using a digital dynamometer. Orthostatic hypotension was measured a week after admission to the ward by the tilt table test. Successful rehabilitation was defined as a Montebello Rehabilitation Factor Score Revised above 50%.

RESULTS

Data were collected for 253 patients. The mean age was 80.5 ± 7.7 and 32.4% were males. The mean handgrip strength was 17.2 ± 6.6 kg. Orthostatic hypotension was diagnosed in 32.8%. One hundred ninety-three patients (76.3%) reached the goal of Montebello Rehabilitation Factor Score Revised ≥ 50 at the end of the rehabilitation. In a logistic regression analysis, handgrip strength, cognitive state, and sex were associated with successful rehabilitation.

CONCLUSIONS

Measuring handgrip strength, but not orthostatic hypotension, can predict successful rehabilitation.

Machine Learning-Based Model for Grip Strength Prediction in Healthy Adults: A Nationwide Dataset-Based Study

Background: This study aimed to develop machine learning models for estimating the handgrip strength (HGS) in healthy adults and to identify the model with the highest accuracy and generalizability. Methods: Data from the Korean National Health and Nutrition Examination Survey (2014-2019), including 21,147 participants aged >19 years, were analyzed. The maximum HGS was measured using a standardized protocol, with 11 demographic, anthropometric, and physical activity predictors. Polynomial regression (PR), multilayer perceptron (MLP), and extreme gradient boosting (XGBoost) models were developed and evaluated using the root-mean-square error (RMSE) and coefficient of determination (R2). Results: The HGS was found to vary by gender, age, and hand dominance, with males and younger individuals showing higher values. The XGBoost model achieved the highest R2 (0.717), demonstrating superior predictive accuracy and generalizability compared with PR and MLP. Key predictors in the XGBoost model included weight, age, height, and waist circumference, while hand dominance was less significant. Conclusions: The XGBoost model outperformed the MLP and PR models, achieving the highest R2 value. It holds promise for clinical applications, enabling accurate HGS estimation to support early diagnosis, targeted interventions, and personalized goal setting.

Associations Between Upper Extremity Activity Capacity and Strength and Post-Operative Ambulation After Geriatric Hip Fracture: A Prospective Controlled Study

Background/Objectives: This study aimed to investigate the effect of upper extremity activity capacity and hand grip strength on early post-operative ambulation in geriatric patients undergoing hip arthroplasty for hip fracture. Methods: This study included patients over 70 years of age who underwent cementless bipolar hemiarthroplasty for geriatric femoral neck fracture to form a homogeneous cohort. This prospective study was terminated when the number of patients reached 102 after power analysis. Demographic data, cumulative ambulation scores (CASs), quick disabilities of the arm, shoulder, and hand (QDASH) scores, and hand grip strength (HGS) were recorded both pre-operatively and post-operatively (3rd and 30th days). The presence of a linear relationship between the numerical and ordinal variables was analyzed using correlation analysis. Results: The mean age of the patients was 78.8 years (range: 70-93 years). There was a positive correlation between the HGS and CAS (r = 0.717, p < 0.05). A negative correlation was found between HGS, age (r = -0.529, p < 0.05), and QDASH scores (r = -0.408, p < 0.05). There was a negative correlation between the QDASH score, HGS, and CAS, and a positive correlation between the QDASH score and age (p < 0.05). Conclusions: This study showed a direct relationship between post-operative ambulation capacity, upper extremity activity capacity, and hand grip strength in geriatric hip fractures. While older age negatively affects this capacity, upper extremity activity capacity and hand grip strength positively affect it.

Hypnotic drug use and rehabilitation outcomes in post-acute geriatric hip fracture patients: A retrospective study

INTRODUCTION

The use of hypnotic drugs is common in the elderly and is associated with negative health outcomes. Our aim was to evaluate the prevalence of hypnotic drug usage amongst hip fracture patients undergoing a rehabilitation program and investigate any potential associations between hypnotic drug use and rehabilitation outcomes in a post-acute care setting.

METHODS

A retrospective analysis of 440 geriatric hip fracture patients was conducted from 1/1/2019 to 12/2021 in a geriatric rehabilitation center. The main outcome measures were the Functional Independence Measure (FIM), the motor FIM effectiveness and length of stay (LOS).

RESULTS

Two hundred and twenty-eight (51.7 %) patients out of the entire cohort (440)), were prescribed hypnotic drugs. These patients exhibited a significantly lower rate of diabetes (p = 0.025), a higher rate of depression (p = 0.003), and lower albumin levels (p = 0.023) upon admission to rehabilitation in comparison to untreated patients. No significant differences were observed between the two patient groups in functional rehabilitation outcomes or LOS. Moreover, no correlation was established between the hypnotic drug burden during rehabilitation and the outcome measures. Furthermore, no significant differences were found between patients treated with hypnotic drugs on admission and those who were prescribed these drugs during rehabilitation. The type of hypnotic drug did not affect these results.

CONCLUSION

The use of hypnotic drugs by elderly individuals undergoing a rehabilitation program after a hip fracture is unlikely to have an adverse impact on their short-term rehabilitation outcomes. Consequently, there may not be an immediate necessity to discontinue these drugs upon admission. Nevertheless, the use of hypnotic drugs should be approached with caution and minimized whenever possible due to an increased fall risk and other adverse effects.

Influence of hand grip strength test and short physical performance battery on FRAX in post-menopausal women: a machine learning cross-sectional study

BACKGROUND

Impaired physical performance and muscle strength are recognized risk factors for fragility fractures, frequently associated with osteoporosis and sarcopenia. However, the integration of muscle strength and physical performance in the comprehensive assessment of fracture risk is still debated. Therefore, this cross-sectional study aimed to assess the potential role of hand grip strength (HGS) and short physical performance battery (SPPB) for predicting fragility fractures and their correlation with Fracture Risk Assessment Tool (FRAX) with a machine learning approach.

METHODS

In this cross-sectional study, a group of postmenopausal women underwent assessment of their strength, with the outcome measured using the HSG, their physical performance evaluated using the SPPB, and the predictive algorithm for fragility fractures known as FRAX. The statistical analysis included correlation analysis using Pearson's r and a decision tree model to compare different variables and their relationship with the FRAX Index. This machine learning approach allowed to create a visual decision boundaries plot, providing a dynamic representation of variables interactions in predicting fracture risk.

RESULTS

Thirty-four patients (mean age 63.8±10.7 years) were included. Both HGS and SPPB negatively correlate with FRAX major (r=-0.381, P=0.034; and r=-0.407, P=0.023 respectively), whereas only SPPB significantly correlated with an inverse proportionality to FRAX hip (r=-0.492, P=0.001). According to a machine learning approach, FRAX major ≥20 and/or hip ≥3 might be reported for an SPPB<6. Concurrently, HGS<17.5 kg correlated with FRAX major ≥20 and/or hip ≥3.

CONCLUSIONS

In light of the major findings, this cross-sectional study using a machine learning model related SPPB and HGS to FRAX. Therefore, a precise assessment including muscle strength and physical performance might be considered in the multidisciplinary assessment of fracture risk in post-menopausal women.

Anticoagulation drug use and rehabilitation outcomes in post-acute hip fractured patients

PURPOSE

To assess the relationship between anticoagulant use and rehabilitation outcomes in post-acute hip fracture patients.

METHODS

A retrospective study (1/2017 to 5/2019) of 299 hip fractured patients.

OUTCOME MEASURES

Functional Independence Measure (FIM) and the motor FIM's effectiveness.

RESULTS

Patients treated with anticoagulation drugs exhibited a significant longer latency time from fracture to surgery (U = -4.37, p < 0.001) and from surgery to rehabilitation (U=-2.27, p = 0.023), and a significantly higher rate of cardiovascular diseases (χ2=0.15, p= 0.023) compared with untreated patients. No significant differences between the two patient groups were found regarding the rate of blood transfusions, perioperative complications (infections, reoperation), or functional outcome measures.

CONCLUSIONS

Oral anticoagulants are not associated with rehabilitation outcomes of hip fracture patients.Implications rehabilitationAnticoagulation drug use is not associated with functional outcome of post-acute hip fracture patients.It is recommended to renew oral anticoagulants for patients on chronic treatment after surgery since no negative outcomes were found during rehabilitation under anticoagulant treatment and in light of the importance of these drugs in preventing thromboembolic complications.

Does Hand Grip Strength (HGS) Predict Functional Independence Differently in Patients Post Hip Replacement Due to Osteoarthritis versus Patients Status Post Hip Replacement Due to a Fracture?

PURPOSE

The aim of the study was to determine whether hand grip strength (HGS) predicts functional independence in older patients who have undergone hip replacement due to osteoarthritis versus older patients who have undergone hip replacement surgery due to fracture.

PATIENTS AND METHODS

The study included 239 patients aged 65 and over in the first weeks after total hip replacement during rehabilitation treatment. Multivariate linear regression was used to determine HGS as a predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) in both groups: patients post hip replacement due to osteoarthritis and patients post hip replacement due to a fracture.

RESULTS

Analysis showed that pre-rehab HGS in the osteoarthritis group predicts improved activities of daily living after rehabilitation (ADL, OR = 1.098; CI 95% 1.052-1.147 and IADL, OR = 1.182; CI 95% 1.103-1.267) and 6 months after (ADL, OR = 1.191; CI 95% 1.066-1.329 and IADL, OR = 1.096; CI 95% 1.012-1.186). In the fracture group, HGS predicts the ADL (OR = 1.081; CI 95% 1.015-1.152) after rehabilitation, and IADL after rehabilitation (OR = 1.122; CI 95% 1.046-1.205) and 6 months after (OR = 1.090; 95% CI 1.021-1.64).

CONCLUSION

HGS in patients after hip replacement surgery predicts functional independence in basic and complex activities of daily living. This can allow the identification of osteoarthritis patients with low hand grip - who can be considered as patients with a higher risk of an unsatisfying outcome of surgery. These patients should undergo pre-rehabilitation and should be monitored, and/or supported in terms of rehabilitation after discharge.

Wearable Activity Trackers Objectively Measure Incidental Physical Activity in Older Adults Undergoing Aortic Valve Replacement

BACKGROUND

For older adults with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR), recovery of physical function is important, yet few studies objectively measure it in real-world environments. This exploratory study explored the acceptability and feasibility of using wearable trackers to measure incidental physical activity (PA) in AS patients before and after AVR.

METHODS

Fifteen adults with severe AS wore an activity tracker at baseline, and ten at one month follow-up. Functional capacity (six-minute walk test, 6MWT) and HRQoL (SF 12) were also assessed.

RESULTS

At baseline, AS participants (n = 15, 53.3% female, mean age 82.3 ± 7.0 years) wore the tracker for four consecutive days more than 85% of the total prescribed time, this improved at follow-up. Before AVR, participants demonstrated a wide range of incidental PA (step count median 3437 per day), and functional capacity (6MWT median 272 m). Post-AVR, participants with the lowest incidental PA, functional capacity, and HRQoL at baseline had the greatest improvements within each measure; however, improvements in one measure did not translate to improvements in another.

CONCLUSION

The majority of older AS participants wore the activity trackers for the required time period before and after AVR, and the data attained were useful for understanding AS patients' physical function.

Vitamin D levels in post-acute hip fractured patients and their association with rehabilitation outcomes

PURPOSE

To report on serum 25-hydroxyvitamin D (25(OH)D) levels in post-acute hip fractured patients, revealed the associations between serum 25(OH)D levels and hip fractured patients' baseline characteristics and rehabilitation outcomes.

MATERIALS AND METHODS

A retrospective study (9/2017-9/2020) of 493 hip fractured patients. 25(OH)D levels were recorded following the patient's baseline characteristics and outcome measures, including the functional independence measure and motor functional independence measure effectiveness. The sample was divided into three groups: deficient (<30 nmol/l), insufficient (30-75 nmol/l) and sufficient (>75 nmol/l) 25(OH)D levels. ANOVA and chi-square test tests compared the groups. Multiple linear analysis assessed the associations between the 25(OH)D and discharge functional independence measure score.

RESULTS

25(OH)D deficiency was found in 20.3% of the patients. The only baseline characteristic significantly associated with serum 25(OH)D levels was dementia. The group with deficient levels of 25(OH)D exhibited a significantly higher rate of low education, low admission albumin levels and a reduced handgrip strength compared to the insufficient/sufficient groups. All functional measure scores were significantly lower in the deficient (25(OH)D) group compared with the insufficient/sufficient patient groups. 25(OH)D levels were found to be significantly associated with the discharge functional independence measure score.

CONCLUSIONS

Routine screening for 25(OH)D levels is mandatory in post-acute hip fracture patients as it may affect rehabilitation outcomes.Implications for Rehabilitation25-hydroxyvitamin D 25(OH)D levels are associated with rehabilitation outcomes in post-acute hip fractured patients.A routine screening for 25(OH)D levels and standardized supplementation protocol during the acute and post-acute rehabilitation setting is recommended as it may improve the quality of care.

Handgrip Strength as a Predictor of Successful Rehabilitation After Hip Fracture in Patients 65 Years of Age and Above

Purpose

It is important to identify factors associated with the outcome of rehabilitation after hip fracture as an aid to planning the rehabilitation framework and the future discharge of patients. Previous studies have shown that handgrip strength (HGS) is one of the factors associated with the success of rehabilitation.

Materials and Methods

A retrospective study among patients 65 years of age and above who underwent surgical repair of a hip fracture followed by rehabilitation in the Geriatrics ward between September 2019 and December 2021. Successful rehabilitation was determined as Montebello Rehabilitation Factor Score Revised (MRFS-R) ≥50%. Associations were assessed between various sociodemographic and clinical variables, including HGS, and rehabilitation success. HGS was tested as a continuous and dichotomous variable, in accordance with various definitions of low muscle strength.

Results

Data were collected for 173 patients. The mean age was 81.2 ± 7.2 years and 68.2% were women. In a logistic regression model only HGS, as a continuous variable, was independently associated with rehabilitation success, with each increase of 1 kg increasing the chance for successful rehabilitation by 6.8%.

Conclusion

HGS is a simple tool for the planning of the rehabilitation process among patients with hip fracture.

Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2

As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.

Low Grip Strength Associated with Clinical Outcomes after Total Hip Arthroplasty - A Prospective Case-Control Study

OBJECTIVE

To assess whether low grip strength (GS) is associated with clinical outcomes after total hip arthroplasty (THA).

METHODS

A prospective case-control study was designed to assess 231 cases of primary THA between January 1, 2015 to May 1, 2018, at an urban tertiary care hospital. Patients were placed into two cohorts based on preoperative GS levels. Low GS in the present study was defined as GS lower than 26 kg for men and 16 kg for women in the dominant hand. Baseline data were prospectively collected and included patient demographics (age, sex, body mass index [BMI]), the surgeon's diagnoses, medical history, length of stay, and American Society of Anaesthesiologists' (ASA) score. Clinical outcomes included surgery- and prosthesis-related variables. The Harris hip score (HHS) and the Short Form Health Survey (SF-12) were completed at the baseline visit and at 1 and 2 years postoperatively in the outpatient department to assess the hip's function and quality of life. Differences in baseline data, length of study (LOS), 90-day postoperative complications, and hospital readmissions were compared. Besides, the correlations between GS and Harris hip score (HHS) and Short Form score (SF-12) were tested.

RESULTS

A total of 202 participants have completed records for analysis finally. The patients were followed up for an average of 24.8 months postoperatively (24-26 months). Eighty-two patients (40.6%) had low GS before THA. Patients with low GS were more likely to be female, older, fracture of femoral head or neck as the primary cause, albumin <3.5 g/dL, and have a lower BMI, higher ASA score, increased rates of the pressure sore, blood transfusion, and LOS compared to normal GS (all P < 0.05). Also, patients in the low GS cohort showed a statistically significant increased unplanned hospital readmissions and decreased discharge home compared to normal GS (both P < 0.05). There was an increasing rate of complications between the two cohorts, for cardiac complications, pressure sore after THA, respiratory complications, urinary tract infection, stroke, and DVT (all P < 0.05). A partial correlation test by controlling medical comorbidities and demographic factors was used to determine the correlation between GS and HHS. There was a significant correlation between them (r = -0.673; P = 0.002). A similar condition was detected in the correlation between GS and SF-12 (r = 0.645; P = 0.001).

CONCLUSIONS

Clinicians should be encouraged to include GS assessment in their evaluation of patients who planned to undergo THA in order to optimize the treatment of high-risk individuals.

Are extracapsular and intracapsular hip-fracture patients two distinct rehabilitation subpopulations?

PURPOSE

To assess whether intracapsular and extracapsular hip fracture patients in a post-acute rehabilitation setting differ in their background characteristics and whether fracture type affects rehabilitation outcome.

METHODS

A retrospective cohort study.

OUTCOME MEASURES

Functional Independence Measure (FIM), motor FIM (mFIM), mFIM effectiveness, length of stay (LOS), and discharge destination. Various tests assessed associations (the Mann-Whitney U, the chi-square, logistic regression), population differences (t-test), and independent predictors of discharge FIM score (multiple linear regression model).

RESULTS

Six hundred and eighty-seven patients completed the rehabilitation program. The intracapsular hip fracture patient group was characterized by significantly higher percentages of males, higher education levels, and living with a caregiver compared with the extracapsular hip fracture patient group. Intracapsular hip fracture patients were younger, had longer latency time from fracture to surgery, exhibited higher functional levels on admission and upon discharge, higher cognitive function and shorter rehabilitation time than extracapsular hip fracture patients. Both study groups possessed similar comorbidities, rehabilitation achievements, and discharge destination. Regression analyses showed that the fracture type was not associated with discharge FIM score, nor with the probability of achieving a favorable functional gain.

CONCLUSIONS

Post-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations. Nevertheless, given additional time, extracapsular hip fracture patients will attain similar functional achievements as intracapsular hip fracture patients.Implications for rehabilitationPost-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations.Given additional time, extracapsular hip fracture patients can attain similar functional achievements as intracapsular hip fracture patients.

Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra‑BR study

BACKGROUND

Handgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years.

METHODS

Participants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) subjects comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of subjects falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) subjects.

RESULTS

Across strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided.

CONCLUSION

NRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures.

How does the multidimensional frailty score compare with grip strength for predicting outcomes after hip fracture surgery in older patients? A retrospective cohort study

Background

Frailty and low handgrip strength (HGS) are associated with adverse outcomes after hip fracture (HF) surgery. We aimed to compare the predictive role of frailty and HGS for adverse outcome in HF patients.

Methods

We included older patients (age ≥ 65 years) who underwent HF surgery to compare the predictive role of HGS and hip-multidimensional frailty score (Hip-MFS) for postoperative complications and mortality. The Hip-MFS was calculated based on comprehensive geriatric assessment (CGA), and HGS was measured with a hand dynamometer. The primary outcome was a composite of postoperative complications (e.g., pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcomes were 6-month mortality and mortality at the end of follow-up.

Results

The median observation time was 620.5 days (interquartile range: 367.0–784.8 days). Among the 242 patients (mean age: 81.5 ± 6.7 years, 73.1% women), 106 (43.8%) experienced postoperative complications. The 6-month mortality and mortality at the end of follow-up were 7.4% (n = 18) and 20.7% (n = 50), respectively. The Hip-MFS (odds ratio [OR], 1.250; 95% confidence interval [CI], 1.092–1.432) and HGS (OR, 1.147; 95% CI, 1.082–1.215) could predict postoperative complications. The Hip-MFS could predict both 6-month mortality (hazard ratio [HR], 1.403; 95% CI, 1.027–1.917) and mortality at the end of follow-up (HR, 1.493; 95% CI, 1.249–1.769) after adjustment, while HGS was only associated with mortality at the end of follow-up (HR, 1.080; 95% CI, 1.024–1.139). For mortality at the end of follow-up, predictive models with the Hip-MFS were superior to those with HGS in the time-dependent receiver-operating curve analysis after adjustment (p = 0.017). Furthermore, the addition of Hip-MFS or HGS to the American Society of Anesthesiologists (ASA) classification improved its prognostic ability.

Conclusions

Both the Hip-MFS and HGS could predict postoperative complications and improve prognostic utility when combined with the ASA classification. The Hip-MFS was a stronger predictor of mortality than HGS after HF surgery. HGS could be a useful pre-screening tool to identify patients at a high risk of postoperative complications and those who may benefit from further CGA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02150-9.

Sarcopenic obesity and function in women with subacute hip fracture: a short-term prospective study

BACKGROUND

The prognostic role exerted by the concurrent presence of sarcopenia and obesity after hip fracture has not been elucidated.

AIM

To assess the effect of sarcopenic obesity on ability to function in women with subacute hip fracture.

DESIGN

Short-term prospective study.

SETTING

Rehabilitation hospital.

POPULATION

Women with subacute hip fracture.

METHODS

At admission, grip strength, by a Jamar dynamometer, and body composition by dual-energy x-ray absorptiometry were assessed. Sarcopenia was defined according to the criteria released by the European Working Group for Sarcopenia in Older People in 2019, with both grip strength < 16kg and appendicular lean mass (aLM) < 15kg. Alternatively, aLM/(height)2 < 5.5kg/m2 was substituted for aLM < 15kg to confirm sarcopenia in the women with grip strength < 16kg. Obesity was diagnosed with fat mass exceeding 40% of total body mass. Function was assessed by the Barthel index.

RESULTS

We assessed 183 of 200 women. Sarcopenic women had lower Barthel index scores assessed at the end of subacute inpatient rehabilitation (U=300,0; z=-4.3; P<0.001) and lower Batrhel index effectiveness (U=310,0; z=-4.2; P<0.001) than non-sarcopenic women. Conversely, we found no significant differences in function between obese and non-obese women. The concurrent presence of sarcopenia and obesity did not worsen the functional prognosis versus the presence of isolated sarcopenia. After adjustment for Barthel index scores before rehabilitation, age, hip-fracture type and cognitive impairment, sarcopenia was significantly associated with Barthel index scores (P=0.001) and Barthel index effectiveness (P<0.001), whereas obesity was not. The results did not materially change when aLM/(height)2 < 5.5kg/m2 was substituted for aLM <15kg to confirm sarcopenia in the women whose handgrip strength was < 16kg.

CONCLUSIONS

The concurrent presence of obesity did not worsen the negative prognostic role of sarcopenia in the short-term recovery of ability to function after hip fracture in women.

CLINICAL REHABILITATION IMPACT

In women with subacute hip fracture, sarcopenia but not obesity should be assessed to contribute to the prediction of the short-term functional outcome.

Better muscle strength can decrease the risk of arthralgia and back &joint stiffness in Kurdish men; a cross-sectional study using data from RaNCD cohort study

Background

Musculoskeletal disorders can reduce the quality of life and work capacity. The study assessed handgrip strength (HGS) in relation to low back pain and arthralgia in Kurdish men.

Methods

This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 2164 men aged 35–65 years. HGS was measured using a hand-held hydraulic handgrip dynamometer. Low back pain, arthralgia, and joint stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire.

Results

The results showed that 21.39 and 24.58% of studied participants had low back pain and arthralgia, respectively. Among the participants with low back pain, 14.5% had back stiffness, and among those with arthralgia, 12.8% had joint stiffness. The mean of HGS in participants with arthralgia and back & joint stiffness was significantly less than those without these disorders (P < 0.001, P = 0.05, and P = 0.005, respectively). Multiple-adjusted OR and 95% confidence intervals (CI) for arthralgia and back and joint stiffness across muscle strength showed the HGS increase to be associated with a lower risk of arthralgia and back &joint stiffness, but not low back pain.

Conclusions

Higher HGS was associated with a lower risk of arthralgia and back & joint stiffness. However, there was no association between HGS and low back pain. Exercise and adherence to proper nutrition are suggested to enhance muscle strength in order to reduce musculoskeletal pain.

Using Machine Learning to Predict Rehabilitation Outcomes in Postacute Hip Fracture Patients

OBJECTIVE

To use machine learning-based methods in designing a predictive model of rehabilitation outcomes for postacute hip fracture patients.

DESIGN

A retrospective analysis using linear models, AdaBoost, CatBoost, ExtraTrees, K-Nearest Neighbors, RandomForest, Support vector machine, XGBoost, and voting of all models to develop and validate a predictive model.

SETTING

A university-affiliated 300-bed major postacute geriatric rehabilitation center.

PARTICIPANTS

Consecutive hip fracture patients (N=1625) admitted to an postacute rehabilitation department.

MAIN OUTCOME MEASURES

The FIM instrument, motor FIM (mFIM), and the relative functional gain on mFIM (mFIM effectiveness) as a continuous and binary variable. Ten predictive models were created: base models (linear/logistic regression), and 8 machine learning models (AdaBoost, CatBoost, ExtraTrees, K-Nearest Neighbors, RandomForest, Support vector machine, XGBoost, and a voting ensemble). R² was used to evaluate their performance in predicting a continuous outcome variable, and the area under the receiver operating characteristic curve was used to evaluate the binary outcome. A paired 2-tailed t test compared the results of the different models.

RESULTS

Machine learning-based models yielded better results than the linear and logistic regression models in predicting rehabilitation outcomes. The 3 most important predictors of the mFIM effectiveness score were the Mini Mental State Examination (MMSE), prefracture mFIM scores, and age. The 3 most important predictors of the discharge mFIM score were the admission mFIM, MMSE, and prefracture mFIM scores. The most contributing factors for favorable outcomes (mFIM effectiveness > median) with higher prediction confidence level were high MMSE (25.7±2.8), high prefacture mFIM (81.5±7.8), and high admission mFIM (48.6±8) scores. We present a simple prediction instrument for estimating the expected performance of postacute hip fracture patients.

CONCLUSIONS

The use of machine learning models to predict rehabilitation outcomes of postacute hip fracture patients is superior to linear and logistic regression models. The higher the MMSE, prefracture mFIM, and admission mFIM scores are, the higher the confidence levels of the predicted parameters.

The handgrip strength threshold of 16 kg discriminates successful rehabilitation: A prospective short-term study of 258 women with hip fracture

AIM

In 2019 the European Working Group on Sarcopenia in Older People (EWGSOP) indicated weakness as the key characteristic of sarcopenia and released the threshold of 16 kg for handgrip strength to define weakness in women. We aimed to externally validate the 16 kg cut-off point for predicting functional recovery in 258 women with subacute hip fracture admitted to our rehabilitation ward.

METHODS

We assessed handgrip strength by a hand-grip Jamar dynamometer at admission to inpatient rehabilitation and functional ability in activities of daily living by the Barthel index at the end of the rehabilitation course. Successful rehabilitation was defined with a Barthel index score ≥85 and highest possible recovery with a Barthel index effectiveness = 100 %.

RESULTS

A handgrip strength ≥16 kg significantly predicted both successful rehabilitation (χ2 = 23.5, P < 0.001) and highest possible recovery (χ2 = 31.05, P < 0.001). For the women with a handgrip strength ≥16 kg, the odds ratios to gain successful rehabilitation and highest possible recovery were 2.68 (95 % CI from 1.19 to 6.04; P = 0.018) and 2.81 (95 % CI from 1.47 to 5.37; P = 0.002), after adjustment for Barthel index scores before rehabilitation, age, hip-fracture type (either medial or lateral), cognitive impairment and 25-hydroxyvitamin D levels.

CONCLUSION

Our results provide an external validation of the 16 kg handgrip strength threshold recently released to discriminate functional outcomes: it significantly predicted the short-term ability to perform activities of daily living after hip fracture in women.

Measurement and Interpretation of Handgrip Strength for Research on Sarcopenia and Osteoporosis

Handgrip strength (HGS) is associated with several chronic diseases, cognitive decline, length of hospital-stay, and mortality. More importantly, HGS is one of the diagnostic criteria of sarcopenia and gaining attention because of its relevance to bone mineral density (BMD) and osteoporotic fractures. As the measurement of HGS is widely used in clinical practice as well as in research, its accurate measurement and interpretation are becoming more crucial. This review describes how to use different types of dynamometers accurately, the impact of body and arm positions and anthropometric parameters on HGS, the current reference values of HGS for sarcopenia research, and the updates on the relationship between HGS and BMD and osteoporotic fractures.