Date Presented 04/05/19
Primary Author and Speaker: Orit Segev-Jacubovski
Additional Authors and Speakers: Hagit Magen, Adina Maeir
BACKGROUND: Hip fractures, particularly in elderly, result in loss of independence in ambulation, limits in activities of daily living (ADL) and instrumental ADL (IADL), reduced health-related quality of life (HRQoL) and restrictions in participation in daily life situations even one year following the fracture (Dyer et al., 2016; Hallberg et al., 2004; Magaziner et al., 2000). Improvements in functional ability, participation and HRQoL are important outcomes that impact on successful aging (WHO, 2001). A deeper understanding of the relationships between those outcomes can be used by clinicians to inform treatment approaches and outcomes among hip fracture patients.
OBJECTIVE: 1. Examine the trajectory of ADL/IADL functioning and participation among older adults with hip fracture from pre-fracture to 6-months post rehabilitation; 2. Determine the relationship between HRQoL, functional abilities and participation 6-months post rehabilitation; 3. Examine whether functional outcomes can predict HRQoL.
DESIGN: This is a retrospective and prospective study. The participants sustained a hip fracture due to a fall and were initially referred to a university-affiliated major post-acute geriatric rehabilitation center. Data from the patients’ charts was collected relating to their ADL and IADL functional ability pre-fracture based on retrospective report at admission to rehabilitation. In addition, ADL functional ability at admission and upon discharge from the rehabilitation center was collected from the patients’ charts, based on multi-disciplinary scores. Finally, ADL and IADL functional ability, participation and HRQoL assessments were administered at the participants’ homes.
PARTICIPANTS: Fifty-five with mean age of 80.82 (SD = 5.69), agreed to participate in this study’s follow-up evaluation. The inclusion criteria were: 65 years and older, were able to independently leave their home before the fall, Mini Mental State Examination score 24 or above at admission and agreed to participate by signing informed consent. Exclusion criterion were: participants with neurological impairments, admitted from a nursing home, had multiple fractures, pathologic fracture, history of metastatic cancer, were unable to walk before the fracture, non-weight baring post-surgery, or suffering from other medical complications during rehabilitation.
METHODS: Participants completed four rehabilitation outcomes: Functional Independence Measure Motor Scale (mFIM), The Lawton Instrumental Activities of Daily Living questionnaire (IADL), Activity Card Sort (ACS) measuring participation, and SF-12 measuring HRQoL.
ANALYTICAL METHODS: Repeated measures one-way ANOVA, paired t-test and Pearson correlations were calculated to examine the study objectives. Hierarchal linear regressions were conducted for prediction of PCS and MCS of HRQoL. Age was entered in the first block. Motor-FIM, IADL, ACS- LADL, ACS Social-Culture, ACS low-demand and high-demand leisure scores were entered in the second block.
RESULTS: Pre-fracture levels of ADL/IADL function and participation were not attained. Significant correlations were found between HRQoL, functional abilities and participation. Hierarchal linear regression for PCS revealed that only the mFIM entered the regression model, accounted for 23.5% of the variance. For MCS, social-cultural activities accounted for 22% of the variance.
CONCLUSION: Significant loss of functioning and participation was found, persisting 6 months after rehabilitation that impede their HRQoL. ADL functioning and social-cultural activities predicting HRQoL. These finding reinforce occupational therapy's intervention which include improving ADL functioning, mobility, and social participation for promoting HRQoL among elderly with hip fracture.
References
Dyer, S. M., Crotty, M., Fairhall, N., Magaziner, J., Beaupre, L. A., Cameron, I. D., & Sherrington, C. (2016). A critical review of the long-term disability outcomes following hip fracture. BMC Geriatrics, 16, 158. https://doi.org/10.1186/s12877-016-0332-0
Hallberg, I., Rosenqvist, A. M., Kartous, L., Löfman, O., Wahlström, O., & Toss, G. (2004). Health-related quality of life after osteoporotic fractures. Osteoporosis International, 15(10), 834–841. https://doi.org/10.1007/s00198-004-1622-5
Magaziner, J., Hawkes, W., Hebel, J. R., Zimmerman, S. I., Fox, K. M., Dolan, M., … Kenzora, J. (2000). Recovery From Hip Fracture in Eight Areas of Function. Journal of Gerontology, 55(9), M498–M507. https://doi.org/10.1093/gerona/55.9.M498
World health organization (WHO) (2001) . The International Classification of Functioning Disability and Health – ICF.Geneva, World health organization.
