Development of a prognostic model to predict post-operative mobility of patients with fragility hip fractures: a retrospective cohort study

Impact of early postoperative ambulation on gait recovery after hip fracture surgery: a multicenter cohort study

The study aimed to investigate the effect of early postoperative ambulation on gait recovery at the initial postoperative week and at discharge after hip fracture surgery in older patients. In this prospective cohort study, 882 patients aged ≥ 65 years from 10 acute hospitals in Japan were divided into early-ambulation (EA) (ambulation initiated on postoperative day 1 or 2) and late-ambulation (LA) (ambulation initiated on postoperative day 3 or later) groups. The Functional Independence Measure (FIM) was assessed 1 day postoperatively, 1 week postoperatively, and at discharge. Independent walking regardless of walking aids was defined as walking FIM ≥ 5. Multivariate logistic regression analysis and a generalized linear mixed model, accounting for inter-hospital variability, determined whether EA affected independent walking at 1 week postoperatively and at discharge. The number of patients walking independently 1 week postoperatively and at discharge was 156 (17.7%) and 292 (33.1%), respectively. On multivariate logistic regression analysis, EA was associated with independent walking at 1 week postoperatively (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.17-4.94; P < 0.0001) and at discharge (OR 3.33; 95% CI 2.38-4.69; P < 0.0001). This study highlights the importance of EA in promoting postoperative independent walking, regardless of hospital setting.

Association between early sitting and functional mobility recovery after hip-fracture surgery in older patients: a prospective cohort study

BACKGROUND

Hip fractures significantly impact older adults, leading to compromised mobility and various adverse outcomes. The importance of early post-surgery mobilization in regaining pre-fracture levels of mobility is recognized, but lacks standardized definitions and implementation strategies. This study aimed to assess the impact of early sitting position 24 h after hip-fracture surgery on functional mobility recovery after 30 days using data from the Spanish National Hip Fracture Registry (RNFC).

METHODS

Prospective cohort study, including patients aged ≥ 75 years admitted for hip-fracture surgery between 2017 and 2020 at Sant Camil Residential Hospital. Data from the RNFC were analyzed, and linear regression models were developed to assess the association between early sitting after surgery (ESAS) and mobility recovery at 30 days after surgery.

RESULTS

Of 486 identified patients, 321 were included, with an estimated ESAS prevalence of 38.32% (95% CI: 32.97-43.88). ESAS was significantly associated with improved mobility recovery at 30 days. Multivariate regression models consistently revealed ESAS as a modest independent predictor of better post-surgery mobility. Factors such as age, cognitive capacity, and general health also impacted mobility recovery.

CONCLUSION

The ESAS effect, while modest, emerges as a significant predictor of hip mobility recovery among older patients with hip fractures 30 days after surgery. These findings underscore the potential of this low-risk, low-cost intervention in enhancing functional mobility recovery strategies and emphasize the need for further research to uncover its broader implications in post-operative care. Implementation of early sitting could be enhanced, as only a third of patients in our study underwent this simple intervention.

Development and validation of a clinical prediction rule for walking independence in hospitalized older adults with a vertebral compression fracture

OBJECTIVE

No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs.

PATIENTS AND METHODS

We conducted a retrospective cross-sectional observational study of patients aged ≥60 years who were hospitalized for VCF at four hospitals in Japan in 2019-2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10-m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut-off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping.

RESULTS

Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut-off of 45 points) were identified as significant predictors. We created a CPR using these two items (0-2 points). The CPR's AUC was 0.92 (0.874-0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965.

CONCLUSION

The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut-off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence.

Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study

Background

After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand.

Objective

This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery.

Methods

A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis.

Results

The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001).

Conclusion

The study's results provide valuable insights for nurses to target these modifiable factors to enhance patients' mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study

Background

The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources.

Methods

This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery.

Results

Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively.

Conclusions

This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.