Factors that predict failure to regain basic mobility after hip fracture surgery

Abstract

Background: Hip fractures are associated with a loss of function often leading to permanent disability and decreased independence in daily living. Regaining basic skills in mobility after hip fracture surgery is considered an important goal in rehabilitation during hospitalization in the early postoperative period. Basic mobility can be assessed by the cumulated ambulation score (CAS) and reflects the ability to get in and out of bed, rise from a chair and walk indoors. Worldwide there is a tendency towards accelerating clinical pathways and therefore early understanding of factors that will limit regaining basic mobility and early discharge are particularly timely to investigate. Purpose: To investigate factors that predict failure to regain basic mobility assessed by the cumulated ambulation score (CAS), on the fifth postoperative day and at discharge after hip fracture surgery. Methods: This study was conducted as a prospective cohort study monitoring early rehabilitation during hospitalization of 274 consecutive patients with a hip fracture operated during the period from September 2012 until June 2013. Patients that could not exercise according to a standard programwere excluded (main reasons were transfer, simultaneous fractures and dead), leaving 167 patients for analysis. Basic data was collected which included patient demographics, prefracture functional level (assessed by New Mobility Score), method of operation, postoperative hemoglobin, and prefracture basic mobility (assessed by CAS). Basic mobility (CAS) and completion of physiotherapy was assessed and recorded daily by the attending physiotherapist. Odds Ratios (OR)with 95%Confidence Intervals (95%CI)were estimated by multivariate logistic regression. Results: 43%had regained their preoperative basicmobility 5 days postoperative. At discharge, 68% had regained their preoperative basic mobility. The median length of stay was 7 days (range: 1–18). Significant predictors (given as adjusted OR (95%CI)) of not regaining basic mobility on the fifth postoperative day were: Age >80 years 7.5 (2.9–19.1), low prefracture functional level 3.0 (1.1–8.2), not completing physiotherapy on the first postoperative day 4.6 (2.0–10.8) and a hemoglobin 80 years 4.3 (1.8–10.1), prefracture functional level 7.0 (2.9–17.0) and not completed physiotherapy on the first postoperative day 3.3 (1.3–8.0). Conclusion(s): This study suggests that patients undergoing hip fracture surgery, who are not able to complete physiotherapy on the first postoperative day, are at greater risk of not regaining basic mobility during hospitalization. Furthermore, a low hemoglobin value on the first postoperative day has a negative impact on the patient’s ability to regain basic mobility. Finally, this study confirms the findings of previous studies, establishing age and preoperative functional level as independent predictors of not regaining basic mobility. Implications: Our findings give clinicians some easily accessible parameters that can identify patients at increased risk of not regaining basic mobility during hospitalization. As a result of this, interdisciplinary treatment may be targeted against the individual needs of the patient at risk, and planning of discharge may start during the early phase of hospitalization.