Activities of daily living after hip fracture: profile and rate of recovery during 2 years of follow-up.

SUMMARY: In this study 509 hip fracture patients were followed-up during 24 months measuring their recuperation in activities of daily living. The different activities measured had both different profile and probability of recovery. INTRODUCTION: Recovery of pre-fracture functional level is a goal of hip fracture treatment. The objective of this study was to measure recovery of previous functional level for ambulation and for the activities of daily living during the 24 months after osteoporotic hip fracture. METHODS: This is a longitudinal prospective study of the patients admitted to the orthopaedics department of a university hospital for hip fracture and followed up by a geriatrician during three years (2003-2005). Demographic, clinical, functional and treatment data were collected during hospitalisation. Telephone follow-up was made at 3, 6, 12 and 24 months. Data were analysed by survival analysis applying the Kaplan-Meier estimator. RESULTS: Five hundred and nine patients were included. The mean age was 84.5 (SD 6.3) years. The activities with lower probability of recovery to the previous level at 24 months were climbing stairs, chair/bed transfers, ambulation, dressing, bathing and use of toilet (between 67.5% and 76% recovery). The activities with higher probability of recovery were grooming, feeding and bladder and bowel control (between 86.3% and 95.4%). Recovery of previous performance level for ambulation, chair/bed transfers, use of toilet, feeding, grooming and bladder control occurred primarily during the first 6 months, whereas recovery of bathing, dressing and climbing stairs occurred mainly in the first 12 months after the fracture. CONCLUSIONS: The activities with lower likelihood of recovery were ambulation, chair/bed transfers, climbing stairs, use of toilet, bathing and dressing. Time of recovery varied by activity; bathing, dressing and climbing stairs were the activities with the longest recovery time.

[Geriatric management of the frail elderly with hip fracture may improve their clinical outcome]. / La intervención geriátrica puede mejorar el curso clínico de los ancianos frágiles con fractura de cadera.

BACKGROUND: The treatment of osteoporotic hip fracture requires the intervention of different medical specialties. The purpose of this study was to know the clinical profile of patients with an acute hip fracture referred for assessment and management to a geriatric assessment team (GAT) and the influence of this kind of geriatric care in their hospital outcome. PATIENTS AND METHOD: All patients 65 year-old or older admitted in a teaching hospital for a hip fracture in a 12 month period were included. The clinical, functional, cognitive and social status were assessed at admission and at discharge in both groups: the patients managed by the GAT and the patients that were not. The patients' characteristics of both groups were compared, and a multivariant analysis was applied to search the variables independently associated wit a better clinical course. RESULTS: On admission, the GAT patients (n = 202) were significantly (p < 0.05) older (84.4 vs 81.7 years), had more previous functional impairment (Barthel index 72 vs 79), more previous diseases (5.4 vs 3.3) and medications (3.2 vs 1.9), presented more frequency of cognitive impairment (52 vs 41%), of high surgical risk (54 vs 26%) and more need of social assistance at home (57 vs 38%) than non-referred patients (n = 200). At discharge, GAT patients had better functional status (Barthel index 38.5 vs 34), had been surgically treated (92 vs 84%), had received physiotherapy (83.7 vs 66.5%) and walked more (56.1% vs 33.8%) than others. In the multivariant analysis, the GAT intervention shows like an independent variable associated to higher frequency of surgical treatment (OR 4.21; CI, 2.80-6.34), to recovery of walking ability (OR, 8.26; CI, 5.23-13.04) and to receive more medical diagnosis (OR, 79.69; CI: 55.48-114.45). The GAT intervention was not associated to a longer hospital stay. CONCLUSIONS: The patients with hip fracture in acute phase required for management by a GAT are more complex than those who were not consulted. In these patients GAT intervention improve their clinical outcome and the efficiency of hospital admission.

A new hierarchical classification for prognosis of hip fracture after 2 years' follow-up.

OBJECTIVES: To examine the prognostic value of different profiles of hip fracture patients for recovery of pre-fracture functional level and for post-fracture mortality. DESIGN: Observational, longitudinal study. SETTING: University hospital. PARTICIPANTS: Five hundred and eight patients who received surgery for hip fracture and were followed for 24 months post-fracture. MEASUMENTS: Patients were assessed according to age, number of independent activities of daily living (ADLs) and dementia. The probability of recovery of previous ambulation level and mortality was established at 3, 6, 12 and 24 months post-fracture. Patients were first classified according to the seven different profiles previously established by Penrod. A new patient classification system was then created using different patient groups: persons aged 75 or older were first classified based on the number of independent ADLs they could perform (4, 3-2 and 1-0) and were then subdivided according to age (75-84 years and >84 years) and presence of dementia. RESULTS: Mean age was 84.5 (SD 6.3) years. Almost all (90.6%) patients walked independently before the fracture. At 24 months' follow-up, the probability of recovery to previous level of ambulation was 73.6%. The new classification into seven groups had higher prognostic value than Penrod's system. Patients under 75 had 95.1% probability of functional recovery and 9.6% of dying. At the other extreme, those over 84 years with 0-1 independent activities of daily living and dementia had 23.9% probability of recovery and 71.4% of dying. CONCLUSION: Hip fracture patients can be classified into homogeneous groups with different prognostic profiles based on pre-fracture characteristics. This new classification improves Penrod's previous system by establishing groups of patients hierarchically ordered by the probability of recovery and mortality at 3, 6, 12 and 24 months post-fracture.

El test de seis minutos de marcha como predictor de mortalidad en lista de espera para trasplante pulmonar / The six-minute walking test as predictor of mortality on the waiting list for lung transplant

Introducción. La mortalidad en lista de espera de trasplante pulmonar hace necesario identificar los criterios de priorización. Objetivos. Analizar la utilidad del test de 6 minutos de marcha (T6MM), para predecir la mortalidad en lista de espera. Pacientes y métodos. Estudio prospectivo de los pacientes valorados para trasplante entre 1998 y 2007. Las variables analizadas son metros recorridos y saturación de oxígeno (SaO2) mínima durante el T6MM, edad, sexo, diagnóstico y mortalidad en lista. Resultados. Se incluyó a 453 pacientes, el 64,2% varones (49,7±14,8 años). La distancia recorrida fue 322±92 m y la SaO2 mínima, 84,1%±7,6%. Murieron 18 pacientes en lista (4%; intervalo de confianza [IC] del 95%, 2,2%-5,8%). Los pacientes que sobrevivieron caminaron significativamente más que los que fallecieron (321±90 frente a 262±115 m; p = 0,001). De forma similar, cifras de SaO2 < 85% se asociaron al 6,5% de mortalidad, frente al 1% con valores superiores (p = 0,006). Los pacientes con fibrosis quística presentaron una mortalidad mayor que con otros diagnósticos (el 10,4 frente al 3,2%; p = 0,043). El análisis multivariable confirmó la relación de los tres factores de riesgo con la mortalidad. La odds ratio (OR) de muerte en lista para la FQ fue de 5,6 (IC del 95%, 1,7-18,9); SaO2 < 85%, OR = 5,7 (IC del 95%, 1,3-25,1), y para los que caminaron menos de 200 m, OR = 7,3 (IC del 95%, 2,5-21). Conclusiones. Los pacientes con FQ tienen mayor riesgo de mortalidad en lista de espera. Los pacientes que caminan menos de 200 m y/o presentan SaO2 mínima < 85% durante el T6MM tienen alto riesgo de mortalidad en lista, por lo que se debería valorar su priorización(AU)

Introduction. Lung transplant waiting list mortality makes it necessary to prioritize the criteria. Objective. To analyze the role of the six-minute walking test (6MWT) as a predictor of waiting list mortality. Patients and methods. We conducted a prospective study of patients considered for lung transplantation between 1998 and 2007. The variables analyzed were: distance walked in metros and minimum oxygen saturation (SaO2) during 6MWT, age, gender, underlying disease and waiting list mortality. Results. A total of 453 patients were included, 64.2% males, mean age 49.7±14.8years. Mean distance walked was 322±93 m and minimum SaO2 84.1%±7.6%. Eighteen patients on the waiting list died (4%) (95%CI, 2.2-5.8). Those patients in the survival group walked significantly farther than those who had died (321±90 vs. 262±115 m; P=.001). Similarly, 6.5% of patients with SaO2 <85% died compared to 1% with higher values (P=.006). Cystic fibrosis patients had higher mortality than other diagnosis (10.4% vs. 3.2; P=.043). Multivariate analysis confirmed the independent relation between mortality and the three risk factors. The odds ratio (OR) for cystic fibrosis waiting list mortality was 5.6 (95%CI, 1.7-18.9); for SaO2 <85%, 5.7 (95%CI, 1.3-25.1), and 7.3 (95%CI, 2.5-21) for less than 200 m walk. Conclusions. Cystic fibrosis patients have a higher risk of waiting list mortality. Patients who walk less than 200 m and/or have a SaO2 <85% during the 6MWT have a higher risk of waiting list mortality so that their prioritization should be considered(AU)