New Mobility Score Research Articles

Does sarcopenia predict change in mobility after hip fracture? a multicenter observational study with one-year follow-up

BackgroundPatients with hip fracture frequently have sarcopenia and are at great risk of loss of mobility. We have investigated if sarcopenia predicts change in mobility after hip fracture.MethodsThis is a prospective, multicenter observational study with one-year follow-up. Patients with hip fracture who were community-living and capable of walking before the fracture were included at three hospitals in Norway (2011–2013). The primary outcome of the study was change in mobility, measured by the New Mobility Score (NMS). Sarcopenia was determined postoperatively by anthropometry, grip strength, and NMS.ResultsWe included 282 participants and sarcopenia status was determined in 201, of whom 38% (77/201) had sarcopenia, 66% (128/194) had low muscle mass, 52% (116/222) had low grip strength and 8% (20/244) had low pre-fracture mobility (NMS < 5). Sarcopenia did not predict change in mobility (effect 0.2 points; 95% CI –0.5 to 0.9, P = 0.6), but it was associated with having lower mobility at one-year (NMS 5.8 (SD 2.3) vs. 6.8 (SD 2.2), P = 0.003), becoming a resident of a nursing home (odds ratio 3.2, 95% CI 0.9 to 12.4, P = 0.048), and the combined endpoint of becoming a resident of a skilled nursing home or death (odds ratio 3.6, 95% CI 1.2 to 12.2, P = 0.02).ConclusionsSarcopenia did not predict change in mobility in the year after hip fracture.

Mobility one week after a hip fracture – can it be predicted?

ObjectiveBetter patient outcomes and more efficient healthcare could be achieved by predicting post hip fracture function at an early stage. This study aimed to identify independent predictors of mobility outcome one week post hip fracture surgery. MethodsAll hip fracture inpatients (n=77) were included in this 6 month prospective observational cohort study. Predictor variables were obtained on the first postoperative day and included premorbid function using the New Mobility Score (NMS). Mobility outcome measures one week postoperatively included the Cumulated Ambulatory Score (CAS). Data were analysed with SPSS using binary multiple logistic regression analysis ResultsPatients who fell outdoors (OR 3.848; 95% CI, 1.053-14.061), had no delay to surgery (OR 5.472; 95% CI, 1.073-27.907) and had high pre-fracture function (OR3.366; 95% CI, 1.042-10.879) were predicted to achieve independent mobility (CAS = 6) one week postoperatively. ConclusionFall location, time to surgery and baseline function predict independent mobility one week after hip fracture, and can be used for early rehabilitation stratification. The NMS and CAS are recommended as standardised hip fracture clinical measures. Orthogeriatric and physiotherapy service initiatives may improve early functional outcome.

The effects of habitual functional training on physical functioning in patients after hip fracture: the protocol of the HIPFRAC study

BackgroundThe survivors after hip fracture often report severe pain and loss of physical functioning. The poor outcomes cause negative impact on the person’s physical functioning and quality of life and put a financial burden on society. Rehabilitation is important to improve physical functioning after hip fracture. To maintain the continuity in rehabilitation we have an assumption that it is of utmost importance to continue and progress the functional training that already started at the hospital, while the patients are transferred to short-term stays in a nursing home before they are returning to home. The aim presently is to examine the effects of a functional training program, initiated by the physiotherapist and performed by the nurses, on physical functioning while the patients are at short term stays in primary health care.Methods/designInclusion and randomization will take place during hospital stay. All patients 65 years or above who have sustained a hip fracture are eligible, except if they have a score on Mini Mental State (MMS-E) of less than 15, could walk less than 10 m prior to the fracture, or are terminally ill. The intervention consists of additional functional training as part of the habitual daily routine during short term stays at nursing homes after discharge from hospital. The primary outcome is physical functioning measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are Timed “Up & Go” (TUG), hand grip strength, activPAL accelerometer, and self-reported measures like new Mobility Score (NMS), Walking Habits, University of California Los Angeles (UCLA) activity scale, Fall efficacy scale (FES), EuroQol health status measure (EQ-5D-5 L), and pain.DiscussionIssues related to internal and external validity in the study are discussed. The outline for the arguments in this protocol is organized according to the guidelines of the Medical Research Council (MRC) guidance on how to develop and evaluate complex interventions.Trial registrationClinicalTrials.gov NCT02780076.

Impact of Smoking on Clinical Outcomes of Open Arthrolysis for Post-Traumatic Elbow Stiffness

Background: Neck of femur fractures have a high incidence in old people, and they come together with a high mortality rate. Nottingham Hip Fracture Score (NHFS) was validated as a tool to predict the mortality in patients with a hip fracture. Methods: The predictive capability of NHFS for 30-day mortality for Greek patients who had an operation on a neck of femur fracture was assessed, and then the original NHFS model was compared to a modified one. Practically, we performed the NHFS to the Greek population, and at the same time, we implemented a modified model of the NHFS by replacing the institution with the New Mobility Score (NMS) (Parker and Palmer, 1993) to the evaluated parameters. From April 2009 to November 2012, we ran a prospective study in our institution, collecting full details from 349 patients. We used Statistical Package for Social Sciences (SPSS), version 20 to analyze data. Univariate logistic regression analysis was utilized for expressing the significance, and the odds ratio for every risk factor participated in our research. Multinomial logistic regression analysis was used for predicting statistical indexes for finding the suitability between two important models consisted of just about the same risk factors. Results: Only 85 (24.4%) of a total of 349 patients (average age 80, 82 years) were men. Follow-up for all patients was at least 30 days. NHFS and modified NHFS predictability were compared with the actual mortality rate of the patients. NMS, Admission Abbreviated Mental Test score (AMTS), Sex, Age, and malignancy were found to be the most important individual factors in hip fracture 30-day mortality. We found both the original and the modified NHFS significant predictors of 30-day mortality, but the modified one with the NMS was better for the Greek population. Conclusions: NHFS is a useful tool to predict the mortality in elderly patients with a neck of femur fracture. Replacing the parameter institution with the NMS improves the predictive capacity of the NHFS to the Greek population.

Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Hip Fractures: a Retrospective Study in 113 Patients.

Introduction:The best treatment for intertrochanteric fractures remains controversial. Many methods have been recommended.Aim:We aimed to assess the results of osteosynthesis using the Proximal Femoral Nail Antirotation (PFNA) system.Patients and Methods:We retrospectively analyzed 113 consecutive patients with intertrochanteric fractures treated with PFNA. Fractures were classified in accordance with the AO/OTA classification system into the groups A1, A2 and A3. The postoperative quality of fracture reduction was described as good, acceptable or poor. The location of the blade within the head was recorded as per the Cleveland method. Tip-apex distance (TAD) was used as a method for evaluating screw position. Pre-fracture and postoperative functional level were evaluated by the new mobility score (NMS).Results:The average age at the time of surgery was 75.9 years. The majority, 75 (66.3 %), were unstable fracture types. The reduction was good in 67 (61.4 %) cases. Of the 24 deaths, 19 patients had comorbidities (p < 0.001). The number of deaths in the first 6 months was significantly higher than in the next 6 months (p = 0.001). The mean TAD was 25.6 mm. The Cleveland zone centre-centre was the most common placement of the blade, accounting for 33 (29 %) of the cases. Reoperation was required in four patients. There were four patients with cut-out. The pre-facture mean value NMS was 8.6 (SD 1.1) and the postoperative mean value was 4.3 (SD 3.6).Conclusion:We concluded that PFNA offers biomechanical advantages, but the best position of the blade is still unknown.

The A-test: assessment of functional recovery during early rehabilitation of patients in an orthopedic ward--content, criterion and construct validity.

The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0-5). Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF)] during early inpatient rehabilitation (1st-5th day). Validity was examined through 3 aspects: content validity--floor and ceiling effect, range, skewness; criterion validity--concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS) for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS) for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS) 4 weeks after surgery, Mann-Whitney U test]; construct validity--4 hypotheses: 1) on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2) in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3) results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4) the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. The obtained results were: low floor (1%) and ceiling (2%) effect, range 0-50, skewness 0.57, strong correlation with ILAS for the patients with hip osteoarthritis (r = -0.97, p = 0.000) and with CAS for the patients with hip fracture (r = 0.91, p = 0.000). The patients with the A-test score 35 and more on the fifth day of rehabilitation (n = 46, Md = 4) had significantly higher NMS rank 4 weeks after surgery than the patients with the A-test score less than 35 (n = 59, Md = 2), (U = 379, z = -6.47, p = 0.000, r = 0.63). All 4 hypotheses were confirmed. The A-test is simple and valid instrument for everyday evaluation of pace and degree of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward.

Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery

Background and purpose Clinicians need valid and easily applicable predictors of outcome in patients with hip fracture. Adjusting for previously established predictors, we determined the predictive value of the New Mobility score (NMS) for in-hospital outcome in patients with hip fracture.Patients and methods We studied 280 patients with a median age of 81 (interquartile range 72–86) years who were admitted from their own homes to a special hip fracture unit. Main outcome was the regain of independence in basic mobility, defined as. independence in getting in and out of bed, sitting down and standing up from a chair, and walking with an appropriate walking aid. The Cumulated Ambulation score was used to evaluate basic mobility. Predictor variables were NMS functional level before fracture, age, sex, fracture type, and mental and health status.Results Except for sex, all predictor variables were statistically significant in univariate testing. In multiple logistic regression analysis, only age, NMS functional level before fracture, and fracture type were significant. Thus, patients with a low prefracture NMS and/or an intertrochanteric fracture would be 18 and 4 times more likely not to regain independence in basic mobility during the hospital stay, respectively, than patients with a high prefracture level and a cervical fracture, respectively. The model was statistically stable and correctly classified 84% of cases.Interpretation The NMS functional level before fracture, age, and fracture type facilitate prediction of the in-hospital rehabilitation potential after hip fracture surgery.