Authors (including presenting author) :
Au ILY(1), Chan DCM(1), Yung BPK(1), Lee SKW(1), Chui TKH(2), Tiu KL(2), Lee KB(2), Chan ACM(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital, (2)Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Fragility hip fracture (FHF) is common in elderly after fall, causing functional impairment, institutionalization, mortality and healthcare burden. Annually, over 5,400 patients were admitted to acute hospitals under Hospital Authority in Hong Kong due to FHF while the Queen Elizabeth Hospital (QEH) accounted for 12.6%. FHF is mostly treated operatively to allow early ambulation and regain functional independence.
Discharge planning is crucial to optimize the rehabilitation progress and minimize unnecessary prolonged length of stay. Early identification of appropriate functional outcomes may act as significant prognostic predictors. Physiotherapy plays an indispensable role in rehabilitation and discharge planning. Pre-operative physiotherapy assessment outcomes could be beneficial in determining the early post-operative functional outcomes of patients with FHF in advance.
Objectives :
1) To investigate the relationship among pre-operative physiotherapy assessment outcomes and early post-operative functional outcomes.
2) To estimate the cut-off points for pre-operative physiotherapy assessment outcomes for prediction of post-operative walker.
Methodology :
A retrospective study was conducted. Patients admitted to the Department of Orthopaedics and Traumatology of QEH and entered the preliminary electronic platform of Fragility Hip Fracture Clinical Pathway in QEH from November 2019 to April 2021 were reviewed. Patients received conservative management were excluded. Pre-operative handgrip strength (HGS), premorbid Modified Functional Ambulation Classification (MFAC-premorbid), MFAC at discharge from QEH (MFAC-DC) and Elderly Mobility Scale at discharge from QEH (EMS-DC) were retrieved for analysis. Correlations between pre-operative physiotherapy assessment outcomes (HGS and MFAC-premorbid) and functional outcomes at discharge from QEH (MFAC-DC and EMS-DC) were evaluated by Spearman’s rank correlation coefficient. Receiver operating characteristic analysis was used to estimate pre-operative physiotherapy assessment cut-off points for the prediction of post-operative walker (i.e. MFAC ≥III).
Result & Outcome :
Five hundred and seventy-nine patients (mean age=84.8±7.1 years old) (190 males, 389 females) were reviewed. Significant positive correlations were found between HGS and MFAC-DC (r=0.307, p<0.001), and between HGS and EMS-DC (r=0.278, p<0.001). Significant positive correlations were demonstrated between MFAC-premorbid and MFAC-DC (r=0.435, p<0.001), and between MFAC-premorbid and EMS-DC (r=0.446, p<0.001).
For predicting post-operative walker, HGS cut-off points in male and female patients were 17.1 kilogram-force (sensitivity 65.2%; specificity 52.8%) (p=0.013) and 11.6 kilogram-force (sensitivity 62.6%; specificity 57.6%) (p<0.001) respectively. MFAC cut-off points in male and female patients were both Category VII (male: sensitivity 71.7%, specificity 54.9%, p<0.001) (female: sensitivity 70.7%, specificity 48.3%, p=0.019).
Pre-operative physiotherapy assessment outcomes, including HGS and premorbid MFAC, can help to determine the early post-operative functional outcomes and facilitate the discharge planning in elderly with FHF.
