Authors (including presenting author) :
Cheung EYY, Wong EYW, So JKW, Pow LWS, Lau ACH, Chan BTW, Law SHY, Cheung KTK, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Modified Functional Ambulation Classification(MFAC) and Elderly Mobility Scale(EMS), with well-established reliability and validity[1,2], are outcome measures for hip fracture patients as minimal data set to retrospectively review the effectiveness of rehabilitation. Further investigation on the use of minimal data set for prospective early identification of patients’ prognosis may provide easy and clinician-friendly approach to facilitate development of rehabilitation and discharge planning.
Objectives :
The current study aimed to develop a composite/comprehensive score based on age, MFAC and EMS to estimate pre-discharge mobility status of hip fracture patients and assess its predictive validity.
Methodology :
Patients diagnosed with hip fracture in Kowloon Hospital for in-patient rehabilitation were recruited in the study. The following data was collected by case physiotherapists upon admission: 1.Pre-morbid MFAC(MFACpremorbid), 2.Age, 3.MFAC at admission(MFACadmission), 4.EMS at admission(EMSadmission). MFAC and EMS upon discharge were also collected. Factor analysis was used to aid development of the predictive score. Receiver Operating Characteristics(ROC) curve was used to assess the predictive validity of the score in differentiating patients as dependent walker(MFAC≤III), assisted walker(MFAC IV-MFAC V) or independent walker(MFAC≥VI) upon discharge.
Result & Outcome :
1887 patients(mean age 83.22±8.43) were recruited within the 10-year cohort from 2013-2022. Both MFAC(3.07vs4.42, p<0.001) and EMS(3.81vs8.75,p<0.001) showed significant improvement after in-patient rehabilitation. The predictive score, named MAME score, is developed with the following equation: MAME=MFACpremorbidX2-AgegroupX2+MFACadmissionX3+EMSadmissionX3, where Agegroup denotes the tens-digit of age. Mean MAME score of our cohort was 17.4±11.8. For patient with MFACadmission≤III, MAME score yielded an Area Under Curve(AUC) of 0.817(95%CI:0.793-0.842,p<0.001) with optimal cutoff score of 12(sensitivity:0.727,specificity:0.776) for the criteria as assisted walker upon discharge. While for patient with MFACadmission≤V, the AUC was 0.820(95%CI:0.800-0.841,p<0.001) with optimal cutoff score of 20(sensitivity:0.716,specificity:0.751) for the criteria as independent walker upon discharge. Further analysis found that assisted walker group showed significantly more changed in EMS as compared to dependent walker group(5.09vs2.48,p<0.001). Simple-administrated MAME score at admission showed effective prediction for patients’ mobility status upon discharge. Clinicians can proactively formulate diversified rehabilitation programme and personalized discharge planning at early stage of rehabilitation. Pinpoint training approach based on patient’s potential can be delivered. Furthermore, enhanced improvement in EMS was found in potential assisted walker, which intensive rehabilitation programme may be warranted for this patient group to maximize outcomes. Reference 1. Chau, M. W. R., Chan, S. P., Wong, Y. W., & Lau, M. Y. P. (2013). Reliability and validity of the Modified Functional Ambulation Classification in patients with hip fracture. Hong Kong Physiotherapy Journal, 31(1), 41-44. 2. Smith, R. (1994). Validation and reliability of the Elderly Mobility Scale. Physiotherapy, 80(11), 744-747.
