Handgrip strength: a reliable predictor of postoperative early ambulation capacity for the elderly with hip fracture

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.

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.

Effects of Progressive Resistance Training After Hip Fracture: A Systematic Review

Hip fracture presents high morbidity, mortality, and healthcare costs. Some programs have focused on the effect of progressive strength work on post-hip fracture recovery. Therefore, the objective of this systematic review was to understand the effect of a progressive resistance training program on different variables in adults after hip fracture. This review includes randomized controlled trials that apply progressive strength programs in subjects after a hip fracture. The selected databases are PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Ebsco. A total of 7 studies were selected after screening. These studies were published between 2005 and 2022. Most of the research included adults over 65 years of age, showing a mean age of 77.80 years. In the majority of cases, the programs are applied between 3 and 12 months post-fracture. The most commonly applied intervention time is 3 months. The intervention time of the programs typically lasts for 3 months and includes 3-4 lower limb exercises involving, mainly hip and knee movements. All the investigations assess functional capacity and nearly all research the strength. It is shown that the intensity of strength work progresses from 60 to 80% of 1RM. Progressive strength training programs in post-hip fracture patients generally show an improvement in functional capacity, strength, balance, walking speed, flexibility, and cardiorespiratory fitness. However, the effects on independence, quality of life, self-reported physical disability, depression, and cognitive ability do not show conclusive results, and there is little research in this regard.

Predictive value of preoperative gluteus and iliacus muscle volumes for patient-reported outcomes following total hip replacement: a three-dimensional volumetric analysis

INTRODUCTION

This study aimed to investigate the relationship between hip muscle mass and patient-reported outcomes (PROs) after total hip arthroplasty (THA) surgery for hip disease using 3D volumetric measurements of the gluteus muscle group and iliac muscle.

MATERIALS AND METHODS

Between January 2020 and December 2021, 85 patients who had undergone unilateral THA for osteoarthritis or osteonecrosis of the femoral head were enrolled. Using a 3D modeler program, automatically generated 3D reconstructed images of the hip muscles were obtained, and volumetric measurements were performed. Both unadjusted and height (m2)-adjusted muscle volumes of the gluteus maximus (unadjusted volume: GmaxV; adjusted volume: GmaxI), gluteus medius (unadjusted volume: GmedV; adjusted volume: GmedI), gluteus minimus (unadjusted volume: GminV; adjusted volume: GminI), and iliacus (unadjusted volume: IliacV; adjusted volume: IliacI) muscles were measured on the affected side and both sides. Pearson correlation analysis between muscle volumes and postoperative 12-month PROs were performed.

RESULTS

The preoperative Gmax volume on the affected side was significantly associated with post-operative PROs, especially mHHS (GmaxV: p = 0.026; GmaxI: p = 0.005) and UCLA scores (GmaxV: p = 0.006; GmaxI: p = 0.002). For measurements on both sides, Gmed volume was the sole index showing a significant correlation with postoperative UCLA scores (GmedV: p = 0.023; GmedI: p = 0.043).

CONCLUSIONS

The current study suggests that preoperative gluteus muscle volume may have predictive value for postoperative PROs of hip disease patients who have undergone THA surgery.

Prognostic Factors of Hip Fracture in Elderly: A Systematic Review

The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors.

Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset

We investigated the risk factors for hip fracture in 48,533 European older adults for 8 years from 2013 onward. We identified female gender, age above 80, low handgrip strength, and depression as significant risk factors for hip fracture. Our findings may help identify high-risk populations for hip fractures in pre-clinical settings.

OBJECTIVES

Hip fracture is a major cause of functional disability, mortality, and health costs. However, the identification and characterization of its causative factors remain poor.

METHODS

We investigated demography, handgrip strength (HGS), depression, and multiple age-associated comorbidities for predicting future hip fracture in individuals aged 50 or above from 15 European countries (n = 48,533). All participants were evaluated from 2013 to 2020 using four successive waves of the Survey of Health, Aging, and Retirement in Europe (SHARE).

RESULTS

Altogether, 1130 participants developed hip fractures during the study period. We identified female gender, an advancing age from quinquagenarians onward, and a poor socioeconomic status as critical risk factors for future hip fracture. Having mobility difficulty, a low HGS (< 27 kg in men, < 16 kg in women) and higher scores on Euro-D depression scales were also significant risk factors for hip fracture. Summated scales of hypertension, diabetes mellitus, cancer, Alzheimer's disease, and stroke did not appear as risk factors.

CONCLUSION

Collectively, we report advancing age, female gender, low HGS, and depression as independent risk factors for hip fracture. Our findings are useful in identifying high-risk populations for hip fractures in pre-clinical settings before rigorous evaluation and treatment in clinics.

Sarcopenia as a Preoperative Risk Stratification Tool among Older Adults with Inflammatory Bowel Disease

Sarcopenia, defined as a loss of muscle mass and function, is a physiologic factor that has been implicated as a predictor of adverse postoperative outcomes in many older adult populations. However, data related to sarcopenia in older adults with inflammatory bowel disease (IBD) remain limited. Older adults with IBD are particularly vulnerable to adverse postoperative outcomes, in part, due to muscle depletion from systemic inflammation, malnutrition, and reduced physical activity. However, few patients undergo routine muscle evaluation as a part of preoperative assessment. Moreover, cut-off values for measures of sarcopenia in the literature are modeled after non-IBD populations. The lack of standardized measures and values for sarcopenia in the IBD patient population has led to heterogenous findings and a paucity of preoperative risk stratification tools. Therefore, we aim to explore the scope of sarcopenia as a preoperative risk stratification tool among older adults with IBD.

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.

One-year change in handgrip strength in patients with hip fracture: a prospective comparison with hip disease

BACKGROUND

Handgrip strength (HGS) has been adopted as one of the diagnostic tools for sarcopenia and is gaining attention because of its association with osteoporotic hip fractures. Longitudinal data of HGS at multiple follow-up intervals in older hip fractures are lacking. We aimed to investigate and compare the HGS changes in patients with hip fracture within 1-year with those in patients with hip diseases.

METHODS

This prospective study was conducted between June 2018 and July 2020. The HGS was measured preoperatively, at predischarge, and at 3, 6, and 12 months postoperatively. We prospectively compared the number of patients with low muscle strength (LMS) as well as the HGS changes over time between the two groups.

RESULTS

A total of 115 consecutive patients with hip fracture (n = 58) and hip disease (57) were enrolled. The rate of preoperative LMS was higher in the hip fracture group than control (P = 0.005), but there was no significant difference in the postoperative period (P = 0.343). The mean HGS was lower in the hip fracture group at all measured time periods. The preoperative HGS increased right before discharge (15.2 kg to 17.0 kg), and plateaued thereafter 1-year in the fracture group, whereas there were no statistically significant changes in serial follow-up trends in the control group.

CONCLUSIONS

The preoperative HGS in fracture patients may have been underestimated, due to different position of the arm, insufficient practice, or pain. Subsequently, HGS was rather constant during 1-year indicating no development of general sarcopenia after treatment for hip fracture. Therefore, in hip fracture patients, the predischarge HGS might be more reliable than preoperative HGS.

Acute Sarcopenia after Elective and Emergency Surgery

Sarcopenia is an increasingly recognised condition of loss of muscle mass and function. The European Working Group on Sarcopenia in Older People 2 (EWSOP2) updated their definition in 2018, emphasising the importance of low muscle strength in diagnosis. Acute sarcopenia has been arbitrarily defined as sarcopenia lasting less than 6 months. This review highlights the pathophysiology involved in muscle wasting following surgery, focussing on hormonal factors, inflammation, microRNAs, and oxidative stress. Biomarkers such as GDF-15, IGF-1 and various microRNAs may predict post-surgical muscle loss. The impact of existing sarcopenia on various types of surgery and incident muscle wasting following surgery is also described. The gaps in research found include the need for longitudinal studies looking in changes in muscle strength and quantity following surgery. Further work is needed to examine if biomarkers are replicated in other surgery to consolidate existing theories on the pathophysiology of muscle wasting.

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.

Handgrip strength is associated with length of stay and functional outcomes at 1-year follow up in fragility hip fracture patients

Background/Purpose

Fragility hip fracture (FHF) is the most prevalent fragility fracture, causing deterioration in ambulatory ability and disability. Early detection of patients who are at risk of prolonged hospitalization and functional decline after FHF is crucial as this facilitates post-operative management and healthcare resources allocation. Handgrip strength (HGS) is an easily-administered and cost-effective tool to assess whole body strength. The objectives of this study were to examine the relationship between pre-operative HGS, length of stay (LOS) and functional outcomes at 1-year follow up in patients with FHF in Hong Kong.

Methods

Patients aged 65 years old or above who were admitted to a local acute hospital from April 2017 to March 2020 due to FHF that were treated operatively, and subsequently attended the multidisciplinary fragility fracture clinic at 1-year follow up were evaluated. HGS measured at pre-operative physiotherapy initial assessment, post-fracture total LOS, Modified Functional Ambulation Classification (MFAC) and Elderly Mobility Scale (EMS) at 1-year follow up were retrieved for analysis. Correlation between HGS and LOS was analyzed using Pearson's correlation coefficient. Correlations between HGS and MFAC, and HGS and EMS were analyzed using Spearman's rank correlation coefficient.

Results

One hundred and nineteen patients (mean age = 80.8 ± 7.3 years) (33 males, 86 females) were evaluated. Statistical significant negative correlation between HGS and LOS was found ( r = -0.245, p = 0.007), implying that the lower the HGS, the longer the period of hospitalization. HGS also showed statistical significant positive correlation with MFAC ( r = 0.358, p < 0.001) and EMS ( r = 0.507, p < 0.001), suggesting that the greater the HGS, the better the functional outcomes after 1 year. In short, pre-operative HGS measured by physiotherapists was shown to be associated with LOS and functional outcomes at 1-year follow up.

Conclusion

HGS is significantly associated with patient's LOS, MFAC and EMS after FHF. HGS is an easily-administered and cost-effective tool to facilitate frontline practitioners to determine and stratify patients’ rehabilitation potential and subsequently establish customized rehabilitation and discharge plan, such as intensive training, caregiver education and potential prediction of discharge destination.

Key Messages

HGS is significantly associated with patient's LOS, MFAC and EMS after FHF. HGS is an easily-administered and cost-effective tool to facilitate frontline practitioners to determine and stratify patients’ rehabilitation potential and subsequently establish customized rehabilitation and discharge plan.