Toward a Meaningful Definition of Recovery After Hip Fracture: Comparing Two Definitions for Community-Dwelling Older Adults
| Autor: | Lois Finch, Sara Ahmed, Suzanne N Morin, Nancy E. Mayo, Mohammad Auais |
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| Rok vydání: | 2018 |
| Předmět: |
Male
030506 rehabilitation medicine.medical_specialty Activities of daily living Physical Therapy Sports Therapy and Rehabilitation Gee Tertiary Care Centers Disability Evaluation 03 medical and health sciences 0302 clinical medicine Quality of life Risk Factors Activities of Daily Living medicine Humans 030212 general & internal medicine Mobility Limitation Generalized estimating equation Aged Aged 80 and over Hip fracture Hip Fractures business.industry Rehabilitation Reproducibility of Results Recovery of Function medicine.disease Confidence interval Cohort Quality of Life Physical therapy Female Independent Living 0305 other medical science business Cohort study |
| Zdroj: | Archives of Physical Medicine and Rehabilitation. 99:1108-1115 |
| ISSN: | 0003-9993 |
| Popis: | Objectives To examine the course of recovery and resulting health-related quality of life (HRQL) after low-trauma hip fracture using 2 different definitions of recovery. Design Inception cohort with 8 assessments over 1 year. Setting Participants were recruited from a tertiary-care hospital and followed up in the community. Participants Community-dwelling hip fracture patients (N=47, 75% of all eligible; aged ≥65y). Interventions Not applicable. Main Outcome Measures Prefracture functional level was used to identify subgroups of participants with similar trajectories of mobility over time. Recovery in functional mobility was defined in 2 ways: the "traditional" definition (return to prefracture level of functional mobility) and a "targeted recovery" definition (ability to climb 10 steps). Both were measured using the Lower Extremity Functional Scale. HRQL was measured using the RAND 36-Item Short-Form Health Survey. Results Participants were categorized into 3 subgroups with: low, medium, and high prefracture functional abilities. Agreement between the 2 definitions of recovery (quantified using κ coefficient) was strong for the medium group (.81; 95% confidence interval, .56–1.00), weak for the high group (.46; 95% confidence interval, 0.0–.99), and minimal for the low group (.12; 95% confidence interval, 0.0–.328). Contrary to the traditional definition, patients who achieved targeted recovery had statistically and clinically better HRQL than the rest of the cohort throughout the study (estimated average difference of 10.8 points on RAND 36-Item Short-Form Health Survey; 95% confidence interval, 6.67–15.07). Conclusions The agreement between the 2 definitions of recovery ranged from minimal to strong according to patient group. Using a functional target to define recovery predicted HRQL better. It is vital to consider the definition of recovery carefully for research or clinical practice because it can influence subsequent decisions (eg, endorsing a specific intervention or discharging patients). |
| Databáze: | OpenAIRE |
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