Postoperative Hip Fracture Patients Research Articles

Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case-control study.

Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence. This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity. The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76). The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.

Simplified Pain Management Including Fentanyl TTS in PACU Patients With Hip Fracture Surgery to Improve Patients’ Well-Being: A Double-Blind Randomized Trial

Adequate pain management is eminently relevant for elderly and more vulnerable patients with hip fractures in the setting of pre and postoperative pain. This study compares postoperative hip fracture patients treated with standard pain management with a variety of medications or an approach with only one option in each medication category (nonopioid: acetaminophen; opioid: fentanyl TTS 12,5 mcg/hour; rescue medication: piritramide) to simplify the treatment algorithm for nurses and improve patient well-being. Double-blind randomized controlled trial. The sample was cognitively intact patients (N = 141) with hip fractures in a tertiary university hospital. Administration of fentanyl12mcg/hourtransdermal therapeutic system was administered by the nurses in the postanesthesia care unit (PACU) to address basal wound pain to improve patientwell-beingand patient treatment inthe PACU for24hours to bettercontrolfor early complications. Well-being was equally increased in both groups in comparison to our preintervention data from 35.7% to over 60% and did not differ significantly between the intervention and control group. No statistically significant differences in numeric rating scale scores, rescue opioid dosage (piritramide i.v.) or in complications were present. This one-size-fits-all simplified pain management approach did not improve patient well-being or any other outcome but highlighted the importance of adequate pain management and a sufficient nurse-to-patient ratio.

The Impact of Screening for Perioperative ICU Admission in Geriatric Hip Fracture Patients: A Retrospective Analysis.

Hip fracture patients are a subset of trauma patients with high peri-operative mortality. To mitigate the mortality risk, the use of predictive scoring systems (e.g., RSI or Nomograms) for risk stratification and monitoring of high-risk patients in the intensive care unit (ICU) has been proposed. Screening patients for ICU admission with relatively low-cost tools may achieve high-quality, low-cost care. The aim of this study was to assess the effectiveness and feasibility of screening postoperative hip fracture patients for ICU admission. This is a retrospective single-site study comparing two groups ofpatients, before and after implementation of a hip fracture postoperative screening intervention in a level 1 trauma center in the United States. All hip fracture patients > 55 years of age admitted to the hospital between January 2021 and May 2023 were included. Trauma team members assessed and screened patients postoperatively in the post-anesthesia care unit (PACU), ordering standardized tests, including laboratory tests, a chest x-ray, and electrocardiogram (EKG). Assessment of the effect of the intervention included a comparison of a number of major adverse events (MAEs), mortality, planned and unplanned ICU admissions, ICU length of stay (LOS), and hospital LOS between pre- and post-intervention groups. Propensity score (PS) estimates were used to compare outcomes between the matched participants in the sample. A predictive model for ICU admission for the overall sample was estimated, and discriminative ability was assessed with an area under the curve (AUC) receiver operator characteristics (ROC) analysis. Lastly, feasibility was assessed by compliance with screening intervention and charges per patient related to the intervention. The sample consisted of 290 patients in the pre-intervention and 180 patients in the post-intervention groups, respectively, with a mean age of81.4 ± (9.9) years. There was a significant increase (p<0.01) in planned ICU admissions (OR=2.387, 95% CI (1.430, 3.983)) after screening protocol implementation. There was no significant difference between the pre-intervention group and post-intervention group in the number of MAEs (p=0.392), mortality (p=0.591), ICU LOS (p=0.617), and hospital LOS (p=0.151). When the PS-matched sample (n=424) was analyzed, there was a significant decrease (p=0.45) in unplanned ICU admissions (OR=6.40, 95% CI (0.81, 50.95)) after protocol implementation. Anticoagulants, emergency department (ED) respiratory rate (RR), injury severity score (ISS), number of comorbidities, substance use disorder (SAD), peripheral artery disease (PAD), and chronic obstructive pulmonary disease (COPD) were significant predictors of ICU admission (p=0.002, 0.022, 0.030, 0.034, 0.039, 0.039, and 0.042), respectively, and, demonstrated the discriminative ability between high and low risk for ICU admission (AUC=0.597, 0.587, 0.581, 0.578, 0.513, and 0.587, respectively). The screening intervention was achievable with 99% compliance (Kappa estimate 0.94) among trauma team members with an average charge of $282 per patient. The addition of a postoperative screening intervention for hip fracture patients > 55 years of age is achievable and decreases unplanned ICU admissions in matched samples. Presenting clinical indicators and comorbidities are associated with ICU admission and provide sufficient discriminatory ability as criteria for ICU admission.

Social participation, positive affect, and negative affect in postoperative patients with hip fractures: A cross-sectional study.

This study investigated the social participation, positive affect (PA), and negative affect (NA) of patients with hip fractures after surgery and determined their possible predictive factors. We used a cross-sectional study design to recruit 154 participants with hip fractures post-surgery. Assessment tools included the Barthel Index, the Automatic Thoughts Questionnaire, the Assessment of Life Habits, and the Positive and Negative Affect Schedule. Patients with better functioning in daily living activities experienced more social participation, higher PA, and lower NA. Patients with more positive automatic thoughts experienced more social participation and higher PA. Patients with more negative automatic thoughts experienced more social participation, lower PA, and higher NA. Early rehabilitation and psychosocial interventions should be provided for postoperative hip fracture patients to improve their activities of daily living and emotional well-being.

Changes in physical activity in older adult patients with postoperative hip fractures in convalescent rehabilitation wards during rehabilitation time and during daily activities in the ward: a prospective cohort study.

As the older adult population increases, the number of patients with hip fractures is expected to increase. Hip fractures are a major factor in bedridden patients and decreased activities of daily living. Older adults may have multiple comorbidities, and improving their physical function under comprehensive care is better to meet their needs. Convalescent rehabilitation wards provide comprehensive care and aim to improve the activities of daily living and physical activity in older adults. This study aimed to identify the time of day, including rehabilitation, when physical activities improve in inpatients with subacute postoperative hip fracture, among the many comorbidities of older adults, in comprehensive care, including rehabilitation. This prospective cohort study was conducted in a comprehensive care setting in a subacute rehabilitation ward in a Japanese hospital. Older adult inpatients with a musculoskeletal disease in a subacute rehabilitation ward were divided into the postoperative hip fracture and non-hip fracture patients to examine age, frailty, activities of daily living, and longitudinal physical activity data from objective measures at admission and discharge. Physical activity increased in older adult inpatients with postoperative hip fractures not only during personalized rehabilitation time ( P < 0.001) but also during free activity in the ward ( P < 0.001), despite their tendency to be older, frailer, and lower activities of daily living. In conclusion, postoperative hip fracture inpatients may improve their fitness after receiving comprehensive care.

Factors associated with reacquisition of nocturnal voiding-related movements in postoperative hip fracture patients

Factors associated with reacquisition of nocturnal voiding-related movements in postoperative hip fracture patients

Effect of Home-based Telerehabilitation on the Postoperative Rehabilitation Outcome of Hip Fracture in the Aging Population.

ObjectiveTo investigate the effects of home‐based telerehabilitation based on the Internet‐based rehabilitation management system on hip function, activities of daily living and somatic integrative ability of elderly postoperative hip fracture patients.MethodsFrom June 2020 to November 2020, we recruited 58 elderly postoperative hip fracture patients and randomly assigned them to the telephone group (n = 29) and the telerehabilitation group (n = 29). Both groups received routine discharge instructions, and the former received telephone follow‐up after discharge, while the latter received remote rehabilitation based on the Internet‐based rehabilitation management system. The Harris hip score (HHS), functional independence measure (FIM), timed up‐and‐go test (TUG), and short physical performance battery (SPPB) were used to evaluate the patients' hip function, activities of daily living, and overall somatic ability.ResultsThere was no significant difference between the baseline data of the two groups before the intervention (P > 0.05); no matter after hip replacement or internal fixation, the HHS score and FIM score of both groups increased gradually with the postoperative time, and the scores in the telerehabilitation group were higher than those in the telephone group at 1 and 3 months after the intervention, and the difference was significant (P < 0.05); for patients after hip replacement, the TUG and SPPB scores in the telerehabilitation group were better than those in the telephone group at 3 months after the intervention, and the difference was significant (P < 0.05).ConclusionsThe Internet‐based rehabilitation management system applied to postoperative home rehabilitation of elderly hip fracture patients can improve the functional recovery of the hip joint and enhance the ability to perform activities of daily living and somatic integration to a certain extent. This seems to provide an effective option for conducting home rehabilitation.

Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a protocol for a mixed method study

BackgroundHip fractures in older adults are significant contributors to severe functional decline and disability as well as hospitalization and increased health care costs. Research shows that timely referral to geriatric rehabilitation leads to better patient outcomes. Currently, a wide variability in the timing, the frequency, and the choice of appropriate setting for rehabilitation of hip fracture patients exists.AimEvaluate the feasibility, acceptability, and preliminary effectiveness of PATH4HIP, a pathway intervention for timely transfer of post-operative geriatric hip fracture patients from hospital to rehabilitation to home.MethodsThis is a single-arm, pragmatic feasibility study to measure reach, effectiveness, adoption, implementation, and maintenance of PATH4HIP, a pathway for post-operative hip fracture patients from a large academic health science center to a geriatric rehabilitation service in Ottawa, Canada. During a 6-month period, all hip fracture patients, 65 years of age or older who have undergone surgery and have met the eligibility criteria (n = 96), will be transferred to the geriatric rehabilitation service no later than post-operative day 6. Patients (n = 10–12) and clinicians who are working on the orthopedic team (n = 10–12) and on the geriatric rehabilitation service (n = 10–12) will be invited to participate in an interview to share their feedback on the intervention’s feasibility and acceptability and to provide suggestions to improve PATH4HIP. Descriptive statistics will be used to summarize results of the quantitative data and content analysis will be used to analyze the qualitative data. The study will be open for recruitment from January to July 2022.DiscussionIf feasible, PATH4HIP will result in the reduction of the post-operative acute care length of stay to less than or equal to 6 days, while having no detrimental effect on rehabilitation outcomes such as functional gains, or discharge destination.

Effectiveness of anabolic steroids in improving outcomes for post-operative hip fracture patients: A randomized controlled trial

BackgroundPost-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty. MethodsThis is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery. ResultsThere were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups. ConclusionIntra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery. Level of evidenceI.

The effectiveness of a physiatrist-led acute hospital based postoperative hip fracture inpatient rehabilitation program: A single-center retrospective study

Background Postoperative hip fracture rehabilitation in Singapore has historically been carried out in both acute and community hospitals (CH). An increasing majority of patients with hip fractures now receive inpatient rehabilitation in CH, and it is often believed that Acute hospital (AH) - based rehabilitation may be less cost-effective than their CH counterparts. Objective: This retrospective study aims to review the effectiveness of an AH-based hip fracture postoperative rehabilitation program. Methods This study retrospectively reviewed the database of postoperative hip fracture patients who underwent a physiatrist-led AH-based inpatient rehabilitation from Jan 2010 to Dec 2016. The primary outcomes were the functional improvement assessed by functional independence measure (FIM) and FIM efficiency. The secondary outcome included the length of stay (LOS), successful discharge to home rate, mortality rate, and complication rate. Results A total of 293 cases were included in the study. After participation in the inpatient rehabilitation program, the mean total FIM increased from 83.9 ± 12.7 (mean ± SD) to 93.9 ± 16.2 ( p &lt; .001). The motor FIM increased from 47.1 ± 10.9 to 56.1 ± 10.1 ( p &lt; .001). 269 (91.8%) patients were successfully discharged home. Inpatient mortality was 0.3% (1/293). The complications rate during inpatient rehabilitation was 16.0% with urinary tract infection being the most frequent complication (10.2%). The median LOS for inpatient rehabilitation was 19 days (15, 28). Conclusions After completing a physiatrist-led postoperative hip fracture inpatient rehabilitation program in an acute hospital, patients demonstrated significant functional improvement ( p &lt; .0001). The inpatient rehabilitation program has a high discharge home rate and low in-hospital mortality.

Functional Outcomes among Geriatric Fragility Hip Fracture Patients in a Developing Country: A Comparative Study between Complete and Incomplete Post-operative Rehabilitation

Objective. The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.&#x0D; Methods. This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires – the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.&#x0D; Results. Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D—5L survey showed that a majority of patients who underwent complete rehabilitation reported having ‘no problems’ in terms of self-care, and anxiety or depression. However, the same group had more patients reporting ‘any problems’ in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with ‘any problems’ in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.&#x0D; Conclusion. In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.

Validity, Responsiveness, and Predictive Ability of the Japanese Version of the Cumulated Ambulation Score in Patients with Hip Fracture.

ABSTRACTObjectives:The aim of the current study was to investigate the validity, the responsiveness, and the predictive ability for discharge to own home of the Japanese version of the Cumulated Ambulation Score (CAS-JP). This was achieved by analyzing the CAS-JP after hip fracture surgery at multiple time points until patient discharge.Methods:Patients who underwent hip fracture surgery were evaluated using CAS-JP, the Barthel Index, and walking ability on postoperative day (POD) 1, 7, and 14 and at discharge. Floor and ceiling effects, responsiveness, and correlations between CAS-JP and other functional outcomes were assessed at each time point. The predictive ability of CAS-JP for discharge to own home was also analyzed using the area under the curve (AUC) of the receiver operating characteristic.Results:A total of 121 patients were included in this study. On POD7, POD14, and at discharge, strong correlations were observed between CAS-JP and the Barthel Index (r=0.81, 0.82, and 0.87, respectively), and between CAS-JP and walking status (r=0.82, 0.81, and 0.76, respectively). CAS-JP had a large effect size (1.64–2.25) and standardized response mean (1.49–1.81). The predictive ability of CAS-JP for discharge to own home, as indicated by the AUCs, were 0.73 (95% CI: 0.62–0.83) on POD7 and 0.74 (95% CI: 0.62–0.86) on POD14.Conclusions:CAS-JP has sufficient validity and responsiveness as a mobility assessment tool in postoperative hip fracture patients. Furthermore, this study showed that early postoperative mobility status evaluation using CAS-JP can sufficiently predict discharge to own home.

Impact of malnutrition in surgically repaired hip fracture patients admitted for rehabilitation in a community hospital: A cohort prospective study.

Malnutrition is common and associated with adverse outcomes in geriatric patients with hip fractures. The study aims to evaluate the relationship between the nutritional status and rehabilitation efficiency and functional outcome on discharge in postoperative hip fracture patients. We prospectively evaluated 172 postoperative hip fracture patients who were admitted to the community hospital from November 2019 to November 2020. Nutritional status was assessed by the 7-point Subjective Global Assessment (SGA) within 48h of admission. Patients were assessed for rehabilitation efficiency and functional outcome at the end of their inpatient stay. There were 172 patients recruited with 100 (58.1%) malnourished and 72 (41.9%) well-nourished patients. Patients in the malnourished group were significantly older, needed walking aid assistance prior to sustaining hip fracture, cognitively impaired and had more comorbidities. Malnourished patients had lower rehabilitation efficiency scores (0.27, 95% CI -0.12 - 0.67 vs 1.32, 95% CI 0.88-1.76) and poorer functional outcomes on discharge (OR 21.5, 95% CI 2.45-188.7, p-value <0.001), after adjustment for pre- and post-fracture confounders. Malnutrition was present in more than half the postoperative hip fracture patients admitted to a community hospital in Singapore. This study showed that poor nutritional status is associated with significantly lower rehabilitation efficiency and functional outcome on discharge in hip fracture patients. Given the medical, social and economic stakes relating to hip fractures, it is essential to recognise and treat malnutrition in the hospital and community.

Calcium and Vitamin D Supplementation in Osteoporosis and Fragility Hip Fracture Patients: A Retrospective NHANES Study

AbstractAdequate vitamin D and calcium supplementation therapy in osteoporosis reduces the risk of fragility fractures and correlates with improved mortality outcomes in postoperative fragility hip fracture patients. However, the prevalence of adequate supplementation in this population remains unclear. Our purpose was to describe supplement use among the adult population in United States who have been told they had osteoporosis and identify factors associated with adequate supplementation, particularly in patients with history of hip fracture. The study sample comprised a total of 15,968 respondents from the National Health and Examinations Survey (NHANES 2007–2010, 2013–2014); 1,065 self-reported a diagnosis of osteoporosis and 266 self-reported a history of hip fracture. Additional patient factors were analyzed by multivariable logistic regression to assess associated factors of adequate vitamin D (≥ 600 international unit [IU]/day) and calcium (≥ 1000 mg/day) supplementation. The prevalence of vitamin D and calcium supplementation was significantly higher in the osteoporosis group than without (p = 0.001). However, supplemental intake reached adequate levels (≥ 600 IU/day of vitamin D and ≥ 1000mg/day of calcium) in only 28.8% of individuals with osteoporosis for vitamin D, 51.6% for calcium, and 19.2% for both. Of individuals with additional history of hip fracture, only 14% reported adequate intake of both nutrients. Female sex (odds ratio [OR]: 2.35, p &lt; 0.001), older age (OR: 1.02, p &lt; 0.001), and Caucasian race (OR: 1.456, p = 0.004) were positive factors of adequate supplementation, while Hispanic ethnicity was a negative factor (OR: 0.658, p = 0.009). Unexpectedly, a history of hip fracture did not affect the odds of adequate treatment (OR: 0.685, p = 0.176). Adults with known osteoporosis in the United States are self-reporting inadequate supplementation therapy, and significant gender and racial disparities exist. There is a broad need for improved supplementation to help manage this disease, particularly among adults with prior hip fracture, a vulnerable population most relevant for orthopaedic surgeons. This study serves as a call-to-action for orthopaedic surgeons to ensure their fragility hip fracture patients receive adequate supplementation postoperatively to maximize their health and recovery. This was a Level III, retrospective cohort study.

Incidence of deep vein thrombosis in postoperative hip fracture patients in Tertiary Care Hospital Chitradurga

Incidence of deep vein thrombosis in postoperative hip fracture patients in Tertiary Care Hospital Chitradurga - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.063, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Functional Predictors for Home Discharge after Hip Fracture in Patients Living in Sloped Neighborhoods or Islands: An 8-Year Retrospective Cohort Study

Functional predictors of home discharge after hip fractures have been widely reported; however, no study has considered the geographical features surrounding patients’ homes. This study aimed to identify home discharge predictors and determine the cutoff points required for home discharge of patients living in sloped neighborhoods or islands. A total of 437 postoperative hip fracture patients were included and classified into the flat, slope, and island groups according to their residential area before the fracture. Multivariate logistic regression analysis was used to identify significant home discharge predictors, and receiver-operating characteristic analysis to calculate cutoff values. In all the groups, the functional independence measure-motor score was a significant home discharge predictor, with cutoff values of 69 for the flat group and 65 points for the slope and island group. In the slope group, the 6-minute walking distance (odds ratio, 1.02; 95% confidence interval, 1.01–1.04) and revised Hasegawa dementia scale score (odds ratio, 1.06; 95% confidence interval, 1.01–1.12) were also identified as predictors, with cutoff values of 150 m and 18 points, respectively. The outcomes required for home discharge after hip fracture differ depending on the neighborhood terrain, especially for patients living in areas with many slopes and stairs.

The effect of psychological resilience on functional outcomes in post-operative hip fracture patients in a Singapore community hospital

Background: In Singapore, the number of hip fractures per year is projected to increase from 2500 to 9000 by 2050. Psychological factors are increasingly recognised as important predictors of healthy aging. While there are a growing number of studies examining resilience in different populations, there is a paucity of literature examining psychological resilience in individuals with hip fractures. Objectives: We aim to identify the association between high psychological resilience and improved functional outcomes in post-operative hip fracture patients in a Singapore Community Hospital, defined by a Conner-Davidson Resilience Scale 25 (CD-RISC 25) score of 62 and above. Methods: We conducted a pilot prospective cohort study in Bright Vision Community Hospital in Singapore. Post-operative elderly hip fracture patients were invited to participate in the study. Psychological resilience scores were measured on Day 1 of admission using CD-RISC 25. Functional outcomes were then tracked weekly for 21 days while participants underwent rehabilitation using the Modified Barthel Index (MBI). Results: High psychological resilience was found in 52.40% of the post-operative hip fracture participants in this study. Of those participants with high psychological resilience, 55% achieved functional independence ( n = 11), compared with 47.47% of participants with low psychological resilience ( n = 9) – although this result did not achieve statistical significance. Conclusion: One in two post-operative hip fracture patients had high psychological resilience, and our study suggests that patients with high psychological resilience can possibly achieve higher gains in functional scores and achieve functional independence.

Relationship between Timed Up &amp; Go Test and Trunk Function in Postoperative Hip Fracture Patients

Relationship between Timed Up &amp; Go Test and Trunk Function in Postoperative Hip Fracture Patients

Translation, Inter-rater Reliability, Agreement, and Internal Consistency of the Japanese Version of the Cumulated Ambulation Score in Patients after Hip Fracture Surgery.

ABSTRACTObjectives:The aim of this study was to translate the Cumulated Ambulation Score (CAS) from English into Japanese in cooperation with different types of healthcare providers and to investigate its inter-rater reliability and internal consistency.Methods:Two physical therapists at each of three general hospitals in Japan measured the mobility of 50 consecutive post-operative hip fracture patients on two occasions between 2 and 6 days after surgery using the Japanese version of the CAS (CAS-JP). We analyzed the inter-rater reliability and agreement using both the linear weighted kappa and the interclass correlation coefficient; we also analyzed the internal consistency using Cronbach’s alpha coefficient.Results:The mean age of patients was 81 (SD: 11.6) years and 82% were women. Approximately half of the patients had severe cognitive impairment. Kappa was ≥ 0.93 for the three mobility activities and for the total CAS-JP score, the percentage agreement was ≥ 0.98, the ICC was ≥ 0.95, and Cronbach’s alpha coefficient was 0.85.Conclusions:We found that the CAS-JP possessed good inter-rater reliability, agreement, and internal consistency. The CAS-JP is a reliable and easy-to-use evaluation tool suitable for daily clinical practice across different healthcare providers to monitor mobility in older hip fracture patients in Japan. We suggest that CAS-JP be evaluated in future studies for use in younger patients and in other patient groups with mobility problems.

A Framework for Supporting Post-acute Care Transitions of Older Patients With Hip Fracture

ObjectiveImproving care transitions is of critical importance for older patients, especially those with complex care needs. Our study examined the “Transitions of Care” (ToC) of complex, post-acute older adults at multiple time points. The objective of this article is to identify domains relevant to health care transitions of post-acute older patients with hip fracture so as to inform future ToC interventions. DesignHere we conducted a framework-based synthesis of the 12 peer-reviewed manuscripts that were published from our multisite, ethnographic study. Setting and participantsAll 12 manuscripts were based on 1 study, described here. Data were collected in multiple regions, in acute and sub-acute care wards, rehabilitation programs, home care agencies, long-term care and assisted living facilities, and patients' private homes. We completed 51 interviews with 23 postoperative hip fracture patients aged ≥65 years, 24 interviews with 19 family caregivers, and 96 interviews with 92 health care providers. Interviews with patients, family caregivers, and health care providers were conducted at each transition point for a total of 171 individual interviews. ResultsTaken together, our framework analysis of the 12 manuscripts identified 8 themes related to ToC. Two themes, patient complexity and system constraints, are contextual factors that tend to impede ToC and may be less amenable to change. The remaining 6 themes, patient involvement and choice, family caregiver roles, strong relationships, coordination of roles, documentation, and information sharing, have the potential to support and improve ToC. Conclusions and implicationsWith comprehensive data from a range of stakeholders, collected at multiple transition points along the health care continuum, in our final 6 themes we identify potential points of intervention for clinicians and teams seeking to improve ToC for older complex patients.