Prognostic Implications of Predischarge Assessment of Gait Speed After Hip Fracture Surgery
| Autor: | Enrico Benvenuti, Mauro Di Bari, M Grazia Almaviva, Sara Gherardini, Marco Baccini, Claudia Biricolti, Paola Pezzano, Costanza Bertini, Monica Lombardi |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Hip fracture elderly functional assessment prognosis Disability Evaluation 03 medical and health sciences 0302 clinical medicine 030502 gerontology Acute care Humans Medicine Prospective Studies Prospective cohort study Aged Aged 80 and over 030222 orthopedics Centimeter Hip fracture Hip Fractures business.industry Rehabilitation Recovery of Function Odds ratio Prognosis medicine.disease Patient Discharge Confidence interval Walking Speed Preferred walking speed Standard error Physical therapy Female Geriatrics and Gerontology 0305 other medical science business |
| Popis: | Background and purposes Hip fracture represents one of the most severe injuries in the older adults. In long-term survivors, disability is common and walking ability may be considered an important predictor of functional recovery. We investigated whether 4-m gait speed, assessed in older persons early after surgical repair of hip fracture, could predict functional recovery and subsequent development of major clinical outcomes. Methods This was a prospective cohort study. We included adults older than 65 years, admitted to a community acute care hospital with hip fracture, undergoing surgical repair. As soon as the participant was able to stand and walk, using walking aids as needed but with no person's help, the 4-m walking speed was tested as the main predictive variable. The outcome variables included the change in the Barthel Index (BI) from prehospital through 1 year postoperative as a continuous variable and 2 dichotomous outcomes, that is, (1) a decrease in BI greater than 5 points in 1 year and (2) a composite endpoint, combining 5+ points BI decline, death, falls, institutionalization, and need for 24-hour home assistance in 1 year. Results Sixty-two participants (mean age = 85 years) were enrolled and evaluated, on average 6 days (standard error of the mean [SEM] = 0.2) after hip fracture surgery. Compared with prefracture (mean = 96.3; SEM = 0.9), BI decreased 1 month after surgery (mean = 76.5; SEM = 2.1) and recovered only partially at 2 (mean = 84.1; SEM = 2.2) and 12 months (mean = 87.2; SEM = 2.8). A predischarge value of the walking speed below the median (20.5 cm/s) predicted a substantial BI reduction throughout the 12 months. Furthermore, the adjusted risk of a decline in functional status was reduced by 5% (odds ratio = 0.95; 95% confidence interval, 0.91-0.997; P = .038) and that of the combined outcome by 7% (odds ratio = 0.93; 95% confidence interval, 0.88-0.99; P = .013) for each centimeter per second of predischarge walking speed. Discussion and conclusion The 4-m walking speed, measured early after surgical repair of hip fracture, has profound long-term prognostic implications. This assessment approach might prove helpful in clinical decision-making on the postoperative management of older hip fracture persons. |
| Databáze: | OpenAIRE |
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