Date of Award
MSc by research (Master of Science by research)
Dr Frances Horgan
Hip Fractures, Age, Outcome Assessment (Health Care)
The aim of this study was to observe the functional abilities of hip fracture patients at two time points post hip fracture.
Falls and fractures are a major concern for the elderly population as they can result in decreased functional abilities and more dependence to complete activities of daily living within the community.
The use of valid, reliable and sensitive outcome measures is essential to observe functional abilities over time and assess the risk of falls in the future. Eighty-one patients consented to participate in this study with thirty three participating in the early assessment group; these patients were assessed at three and 15 months. For the 81 subjects, the average age was 81 years with a standard deviation of 8.00 years (60 - 96 years). The average age of the 33 subjects was 81 years (sd 8.00, range 65 - 94). A range of measures assessing movement, strength, balance, endurance and extended activities of daily living were applied.
The types of fracture, surgery, length of stay to surgery, types of anaesthesia used, surgical approach used, pain reported, discharge plan from the acute hospital, length of stay were reviewed in both the acute hospital and rehabilitation facility.
At three months the mean Berg balance score was 39.16 (sd12.98, range 18 - 56) and 15 months 38.44 (sd 14.04; range 11 -55) but no significant differences were found (p>0.05).
The mean Timed Up and Go score was 29.90 (sd 18.99; range 0 - 69.18) at three months and 27.27 (sd 18.76; range 0 - 66.38) at fifteen months but no significant differences were found (p>0.05).
The mean six minute walk test scores for the early assessment group were 165.84m (sd 85.34; range 0 - 359.20) at three months and at 15-months 193.72m (sd 110.98; range 0 - 3 84.69), the change was not significant (p>0.05).
At three months the right hand dynamometry mean score was 25.56 (sd 13.57; range 0 - 65) lbs and left hand mean score was 25.48 (sd 10.88; range 6.00 - 46.00) lbs. At fifteen months the right hand dynamometry score was 23.80 (sd 12.67 range 8.67 - 59.33) lbs and left hand dynamometry score was 25.48 (sd 8.47; range 11 - 37.67) lbs. No significant differences were found in grip strength (p>0.05).
The mean pre-fracture Nottingham Extended activities of daily living (NEADL) score was 47.61 (sd 13.14; range 18 - 63) while at three months the mean score was 32.55 (sd 17.26; range 3 - 63) and at fifteen months was 39.45 (sd 18.45; range 1 - 63). Significant differences were found between pre fracture and 3 months (p
In conclusion, no significant functional improvements were observed after 3 months despite significant in-patient input (compared with other countries) and further physiotherapy/rehabilitation input post discharge. Therefore, the findings from this study highlight the need to re-evaluate the current model of care for elderly post hip fracture patients.
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McCarthy S. Evaluation of outcomes of elderly patients at 3 and 15 months post hip fracture [MSc Thesis]. Dublin: Royal College of Surgeons in Ireland; 2011.