What factors are associated with the recovery of autonomy after a hip fracture? A prospective multicentric cohort study

Publication date: Available online 10 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mattia Morri, Paolo Chiari, Cristiana Forni, Antonella Orlandi Magli, Domenica Gazineo, Natalia Franchini, Lorenzo Marconato, Tiziana Giamboi, Andrea Cotti
Objectiveto identify the factors associated with recovering autonomy in the activities of daily livingDesignA prospective cohort studySettingThe orthopedic and orthogeriatric departments of 2 regional hospitalsParticipantsPatients 65 years of age or older with a diagnosis of fragility hip fracture. There were 840 eligible patients. Forty-three patients were excluded and 55 were lost. Seven hundred and forty-two consecutive patients was enrolled at the time of hospitalization and 727 at follow-up.Main Outcome MeasuresThe level of autonomy at 4 months was assessed using the ADL scale.ResultsThe score of the ADL scale at 4 months had a median equal to 3 (IQR=5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B= 0.02; p<0.001), an elevated number of comorbidities (B=0.044; p=0.005); a lower level of prefracture autonomy (B=0.087; p<0.001); more frequent use of an anti-decubitus mattress (B=0.211; p<0.001), an increased number of days with disorientation (B=0.002; p=0.012); failure to recover deambulation (B=0.199; p<0.001); an increased number of days with diapers (B=0.003; p<0.001), with a urinary catheter (B=0.03; p<0.001) and with bed rails (B=0.001; p=0.014), and a non-intensive care pathway (B=0,199; p=0,014).ConclusionIn the initial phase, treatment of patients with hip fractures is significantly associated with the functional recovery of autonomy and should be activated starting from those factors which have the possibility of being modified in clinical practice: recovery of deambulation, treatment for disorientation and management of incontinence.



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