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Factors Affecting Function After Hip Fracture

Posted on: 04/16/2009
Here are a few facts to consider. A quarter of a million people in the United States will fracture their hips this year. One-fourth of those adults die within the first 12 months after that fracture. And only half of those who survive will be able to return home and resume a normal life. Those are very sobering statistics.

Studies show that if this happens to you, your motivation level can be a key factor in your success. Patients who are highly motivated to participate in their rehab program are more likely to have a positive outcome and successful rehab. But how can we measure motivation? And what can we do to increase motivational levels to ensure better results?

These are the kinds of questions physical therapists are faced with everyday. Now that patients go home so much faster after hospitalization, it's even more important than ever that therapists quickly determine what level of participation they can expect from each patient. And it's equally important that patients fully participate in their own recovery process whenever possible.

In this study, physical activity was measured objectively using a special device called an actigraph accelerometer. The accelerometer has an electronic sensor that records frequency, intensity, and duration of physical activity. It provides a reliable measure of energy used up during activity by transferring that activity into activity counts. Data on activity counts for healthy, young adults walking on a treadmill is available for comparison.

Patients over the age of 60 who were independent in getting around the house and community before having a hip fracture were included in the study. Some used a cane, walker, or the assistance of another person but all were fully weight-bearing and functional. They all qualified as being what we call community dwelling individuals.

Each patient wore the monitor on the waistband of their pants. The accelerometer was placed on the uninvolved side. The device picks up vertical movements of the trunk and records them as activity counts per minute. One count per minute is equal to four milligrams of gravitational force per second.

During the five days that the patients wore the accelerometer, their physical therapist also recorded their level of participation during their therapy. They used a tool called the Pittsburgh Participation Rating Scale that ranks patient participation on a scale from 1=none up to 6=excellent. The therapist completed the scale for each patient after each session for the five days of the study when they were wearing the accelerometer.

In addition, function was measured using the Hip Fracture Functional Recovery Scale. This is a self-report survey completed by the patient answering questions about daily self-care. Activities included shopping, dressing, eating, toileting, housework, errands, and mobility (walking).

By comparing these three measures (activity counts, participation, and function), it was possible to see some trends within the patient groups. For example, patient with higher activity counts also had excellent participation scores. The more active patients were, the better their function, too. And these results were consistent when reviewed at the end of three and six months.

Therapists are interested in helping post-fracture patients avoid a decline in function, speed up recovery of function, and foster physical activity to improve function. Looking at activity levels and how these match up to final outcomes is useful information.

The therapist can now use this data to look at factors that might help improve participation levels. This could include patient scheduling, pain level, past medical history, or even how active they were before the fracture compared with now.

Since only movement of the lower half of the bottom was tracked, it's possible activities of the upper extremities may have benefitted the patients without having a way to record or track this influence. Future studies may be able to tackle that link.

Other factors may have affected activity level that were not accounted for in this study such as general health, complications, diagnostic tests performed during the testing period, and so on. It's possible that varying amounts and types of therapy could make a difference too. What if patients had two therapy sessions each day instead of one? Would the results be any different? And finally, future studies should also be done to measure function using something more objective than a patient self-report.

Jaime B. Talkowski, PhD, MPT, et al. Patient Participation and Physical Activity During Rehabilitation and Future Functional Outcomes in Patients After Hip Fracture. In Archives of Physical Medicine and Rehabilitation. April 2009. Vol. 90. No. 4. Pp. 618-622.

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