A Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months after Surgery for Hip Fracture Repair

Publication date: Available online 13 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ryo Tanaka, Takuya Umehara, Takafumi Fujimura, Junya Ozawa
ObjectiveTo develop and assess a clinical prediction rule (CPR) to predict declines in activities of daily living (ADL) at 6 months after surgery for hip fracture repair.DesignA prospective, cohort study.SettingFrom hospital to home.ParticipantsOne hundred and four patients with hip fractures after surgery.InterventionsNo special intervention was employed in this study.Main Outcome MeasureADL was assessed using the Barthel Index at 6 months after surgery.ResultsAt 6 months after surgery, 86 patients (82.6%) were known to be alive, one patient died, and 17 (16.3%) were lost to follow-up. Thirty-two patients (37.2%) did not recover their ADL at 6 months after surgery to levels before fracture. The Classification and Regression Trees (CART) methodology was used to develop two models to predict a decline in ADL: model-1, which included age, type of fracture, care-level before fracture (sensitivity = 0.750, specificity = 0.815, positive predictive value = 70.6%, and positive likelihood ratio = 4.050), and model-2, which included the independence of post-surgery 2 weeks ADL chair transfer and ambulation and age (sensitivity = 0.656, specificity = 0.870, positive predictive value = 75.0%, and positive likelihood ratio = 5.063). The areas under receiver-operator characteristic curves of both CPR models were 0.825 [95% confidential interval (CI) = 0.728–0.923) and 0.790 (95% CI = 0.683–0.897), respectively.ConclusionCPRs with moderate accuracy were developed to predict declines in ADL at 6 months after surgery for hip fracture repair.



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