Abstract
Summary
This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after discharge. We identified 43 studies reporting 74 associated factors to functional recovery; most of them were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity.
Purpose
This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction.
Methods
A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity.
Results
Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12 months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set.
Conclusion
Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity.
Registration number
PROSPERO (CRD42020149563).
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Data availability
Search strategies and references of excluded studies are available on the Electronic Supplemental material.
Code availability
Not applicable.
References
Giraldo MCI, Franco AGM (2008) Capacidad funcional y salud:orientaciones para cuidar al adulto mayor. Av enfer 26(1):43–58
Gómez Montes J, Curcio Borrero C, Gómez Gómez D (1995) Evaluación de la salud de los ancianos. Manizales, editor. Universidad de Caldas. p 57
Lamoureux EL, Sparrow WA, Murphy A, Newton RU (2001) Differences in the neuromuscular capacity and lean muscle tissue in old and older community-dwelling adults. J Gerontol Med Sci 56A(6):M381–M385
Maidan I, Droby A, Jacob Y, Giladi N, Hausdorff JM, Mirelman A (2020) The neural correlates of falls: Alterations in large-scale resting-state networks in elderly fallers. Gait Posture 80:56–61
OMS. Informe Mundial Sobre el Envejecimiento y la Salud (2015) Organización Mundial de la Salud; 2015. p 267
Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P et al (2018) Prognostic factors of functional outcome after hip fracture surgery: A systematic review. Age Ageing 47(5):661–670
Lim KK, Matchar DB, Chong JL, Yeo W, Howe TS, Koh JSB (2019) Pre-discharge prognostic factors of physical function among older adults with hip fracture surgery: a systematic review. Osteoporos Int 30(5):929–938
van der Sijp MPL, van Eijk M, Tong WH, Niggebrugge AHP, Schoones JW, Blauw GJ et al (2020) Independent factors associated with long-term functional outcomes in patients with a proximal femoral fracture: A systematic review. Exp Gerontol. 139(July):111035
Haywood KL, Griffin XL, Achten J, Costa ML (2014) Developing a core outcome set for hip fracture trials. Bone Jt J 96 B(8):1016–23
Smith TO, Collier T, Sheehan KJ, Sherrington C (2019) The uptake of the hip fracture core outcome set: analysis of 20 years of hip fracture trials. Age Ageing 48:595–598
Fletcher J, Sheehan KJ, Smith TO (2020) Barriers to uptake of the hip fracture core outcome set: An international survey of 80 hip fracture trialists. Clin Trials 17(6):712–716
Moppett I (2018) Hip fractures: are we asking the right questions? Age Ageing 47:633–634
Javaid MK, Sami A, Lems W, Mitchell P, Thomas T, Singer A et al (2020) A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture. Osteoporos Int 31(7):1193–1204
Geersing GJ, Bouwmeester W, Zuithoff P, Spijker R, Leeflang M, Moons K (2012) Search filters for finding prognostic and diagnostic prediction studies in medline to enhance systematic reviews. PLoS ONE 7(2):1–6
Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286
Hayden JA, Côté P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144(6):427–437
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, PRISMA, et al (2020) explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ 2021:372
Baztán JJ, Fernández-Alonso M, Aguado R, Socorro A (2004) Resultados al año de la rehabilitación tras fractura de fémur proximal en mayores de 84 años. An Med Interna 21(9):433–440
Boese CK, Buecking B, Schwarting T, Debus F, Ruchholtz S, Bliemel C et al (2015) The influence of pre-existing radiographic osteoarthritis on functional outcome after trochanteric fracture. Int Orthop 39:1405–1410
Boese CK, Buecking B, Bliemel C, Ruchholtz S, Frink M, Lechler P (2015) The effect of osteoarthritis on functional outcome following hemiarthroplasty for femoral neck fracture: A prospective observational study. BMC Musculoskelet Disord 16:304
Buecking B, Boese CK, Seifert V, Ruchholtz S, Frink M, Lechler P (2015) Femoral offset following trochanteric femoral fractures: A prospective observational study. Injury 46(S4):S88-92
Gialanella B, Santoro R, Prometti P, Giordano A, Monguzzi V, Comini L et al (2020) Functional recovery in hip fracture patients: the role of pharmacotherapy. Aging Clin Exp Res 32(1):49–57
Gordon M, Berntsson PO, Sjölund E, Demir Y, Hedbeck CJ, Stark A et al (2016) Loss of offset after pertrochanteric hip fractures affects hip function one year after surgery with a short intramedullary nail A prospective cohort study. Int Orthop. 40(4):799–806
Knauf T, Buecking B, Hack J, Barthel J, Bliemel C, Aigner R et al (2019) Development of the Barthel Index 5 years after hip fracture: Results of a prospective study. Geriatr Gerontol Int 19(8):809–814
Orive M, Aguirre U, García-Gutiérrez S, Las Hayas C, Bilbao A, González N, et al. (2015) Changes in health-related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: A prospective cohort study. Int J Clin Pract 69(4)
Pareja Sierra T, Bartolomé Martín I, Rodríguez Solís J, Bárcena Goitiandia L, Torralba González de Suso M, Morales Sanz MD, et al. (2017) Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano. Rev Esp Cir Ortop Traumatol 61(6):427–35
Pérez-Barquero MM, García Lázaro M, Carpintero BP (2007) Desnutrición como factor pronóstico en ancianos con fractura de cadera. Med Clin (Barc) 128(19):721–725
Savino E, Martini E, Lauretani F, Pioli G, Zagatti AM, Frondini C et al (2013) Handgrip Strength Predicts Persistent Walking Recovery After Hip Fracture Surgery. Am J Med 126(12):1068–1075
Sylliaas H, Thingstad P, Wyller TB, Helbostad J, Sletvold O, Bergland A (2012) Prognostic factors for self-rated function and perceived health in patient living at home three months after a hip fracture. Disabil Rehabil 34(14):1225–1231
Tarazona-Santabalbina FJ, Belenguer-Varea Á, RoviraDaudi E, Salcedo Mahiques E, Cuesta Peredó D, Doménech-Pascual JR et al (2015) Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture. Geriatr Gerontol Int 15(3):289–295
Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira-Daudi E, Salcedo-Mahiques E, Cuesta-Peredó D, Doménech-Pascual JR et al (2012) Early interdisciplinary hospital intervention for elderly patients with hip fractures - Functional outcome and mortality. Clinics 67(6):547–555
van der Sijp MPL, van Eijk M, Niggebrugge AHP, Putter H, Blauw GJ, Achterberg WP (2020) Prognostic Factors for Short-term Recovery of Independence in a Multistate Model for Patients With a Hip Fracture. J Am Med Dir Assoc :1–6
Vochteloo AJH, Moerman S, Tuinebreijer WE, Maier AB, de Vries MR, Bloem RM et al (2013) More than half of hip fracture patients do not regain mobility in the first postoperative year. Geriatr Gerontol Int 1(13):334–341
Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD (1998) Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res 348:22–28
Lenze EJ, Munin MC, Dew MA, Rogers JC, Seligman K, Mulsant BH et al (2004) Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. Int J Geriatr Psychiatry 1(19):472–478
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: A prospective study. J Gerontol 45(3):M101-107
Marottoli RA, Berkman LF, Cooney LM (1992) Decline in physical function following hip fracture. J Age Relat Disord 40:861–866
Mossey JM, Knott K, Craik R (1990) The effects of persistent depressive symptoms on hip fracture recovery. J Gerontol 45(5):M163-168
Parker DC, Colon-Emeric C, Huebner JL, Chou CH, Kraus VB, Pieper CF et al (2020) Biomarkers associated with physical resilience after hip fracture. J Gerontol - Ser A Biol Sci Med Sci 75(10):E166–E172
Rathbun AM, Shardell M, Orwig D, Gruber-Baldini AL, Ostir G, Hicks GE et al (2016) Effects of Prefracture Depressive Illness and Postfracture Depressive Symptoms on Physical Performance After Hip Fracture. J Am Geriatr Soc 64(11):e171–e176
Tang VL, Sudore R, Cenzer IS, Boscardin WJ, Smith A, Ritchie C, et al. (2017) Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med 32(2)
Young Y, Brant L, German P, Kenzora J, Magaziner J (1997) A longitudinal examination of functional recovery among older people with subcapital hip fractures. J Am Geriatr Soc 45(3):288–294
Beloosesky Y, Hendel D (2002) Functional gain of hip fracture patients in different cognitive and functional groups. Clin Rehabil 16:321–328
Beloosesky Y, Weiss A, Manasian M, Salai M (2010) Handgrip strength of the elderly after hip fracture repair correlates with functional outcome. Disabil Rehabil 32(5):367–373
Chen YP, Wong PK, Tsai MJ, Chang WC, Hsieh TS, Leu TH et al (2020) The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture. J Formos Med Assoc 119(12):1807–1816
Fukui N, Watanabe Y, Nakano T, Sawaguchi T, Matsushita T (2012) Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: A 1-year prospective cohort study. J Orthop Trauma 26(3):163–171
Hershkovitz A, Kalandariov Z, Hermush V, Weiss R, Brill S (2007) Factors Affecting Short-Term Rehabilitation Outcomes of Disabled Elderly Patients With Proximal Hip Fracture. Arch Phys Med Rehabil 88:916–921
Hershkovitz A, Nissan R (2020) The Association Between Antipsychotic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study. J Appl Gerontol :1–9
Lin PC, Chang SY (2004) Functional recovery among elderly people one year after hip fracture surgery. J Nurs Res 12(1):72–76
Liu HY, Wang HP, Chen CY, Wu CC, Hua MS, Lin YE et al (2020) Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults. Int J Geriatr Psychiatry 35(10):1209–1218
Takayama S, Iki M, Kusaka Y, Takagi H, Tamaki S (2001) Factors That Influence Functional Prognosis in Elderly Patients with Hip Fracture. Environ Health Prev Med 6:47–53
Jorissen RN, Lang C, Visvanathan R, Crotty M, Inacio MC (2020) The effect of frailty on outcomes of surgically treated hip fractures in older people. Bone 136:1–8
Low S, Wee E, Dorevitch M (2021) Impact of place of residence, frailty and other factors on rehabilitation outcomes post hip fracture. Age Ageing 50(2):423–430
Taylor NF, Peiris CL, Thompson AL, Prendergast LA, Harding KE, Hau R, et al. (2021) Association between physical activity and short-term physical function changes after hip fracture: An observational study. Physiother Res Int 26(1)
Dahlgren G, Whitehead M (1991) Policies and strategies to promote social equity in health
Gialanella B, Ferlucci C, Monguzzi V, Prometti P (2015) Determinants of outcome in hip fracture: role of daily living activities. Eur J Phys Rehabil Med 51(3):253–260
Gialanella B, Ferlucci C, Monguzzi V, Prometti P (2015) Determinants of functional outcome in hip fracture patients: The role of specific neuropsychiatric symptoms. Disabil Rehabil 37(6):517–522
Gialanella B, Santoro R, Prometti P, Bertolinelli M, Monguzzi V, Grioni G (2020) Predictors of balance in older hip fracture patients undergoing standard motor rehabilitation. Eur Geriatr Med
Buecking B, Boese CK, Bergmeister VA, Frink M, Ruchholtz S, Lechler P (2016) Functional implications of femoral offset following hemiarthroplasty for displaced femoral neck fracture. Int Orthop 40:1515–1521
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of Functional Recovery One Year Following Hospital Discharge for Hip Fracture: A Prospective Study. J Gerontol 45(3):M101–M107
Dubljanin-Raspopović E, Marković-Denić L, Matanović D, Grajić M, Krstić N, Bumbaširević M (2012) Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients? Arch Med Sci 8(1):115–122
Gumieiro DN, Rafacho BPM, Gonçalves AF, Tanni SE, Azevedo PS, Sakane DT et al (2013) Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture. Br J Nutr 109:1657–1661
Johansson H, Clark P, Carlos F, Oden A, McCloskey EV, Kanis JA (2011) Increasing age- and sex-specific rates of hip fracture in Mexico: a survey of the Mexican institute of social security. Osteoporos Int 22(8):2359–2364
Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256
Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: A systematic review and meta-analysis. Vol. 43, Injury. Elsevier. p. 676–85
Vázquez-Barquero JL (Contribuyente), Bilbao Bilbao Á (Traductor) (2001) Clasificación internacional del funcionamiento, de la discapacidad y de la salud: CIF. Ministerio de Trabajo y Asuntos Sociales, Secretaria General de Asuntos Sociales, Instituto de Migraciones y Servicios (IMSERSO), editors. Organización Mundial de la Salud. p 320
Podsiadlo D, Richardson S (1991) The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. J Am Geriatr Soc 39(2):142–148
Tinetti ME (1986) Performance-Oriented Assessment of Mobility Problems in Elderly Patients. J Am Geriatr Soc 34(2):119–126
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG et al (1994) A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journals Gerontol 49(2):M85-94
Cabañero-Martínez MJ, Cabrero-García J, Richart-Martínez M, Muñoz-Mendoza CL (2009) The Spanish versions of the Barthel index (BI) and the Katz index (KI) of activities of daily living (ADL): A structured review. Arch Gerontol Geriatr 49(1):e77-84
González N, Bilbao A, Forjaz MJ, Ayala A, Orive M, Garcia-Gutierrez S et al (2018) Psychometric characteristics of the Spanish version of the Barthel Index. Aging Clin Exp Res 30(5):489–497
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 51(4):737–55
Nilsdotter A, Bremander A (2011) Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (A. Arthritis Care Res (Hoboken) 63(S11):S200–7
NCBI, US NLM (2020) Recovery of Function - MeSH - NCBI. Available from: https://www.ncbi.nlm.nih.gov/mesh/?term=functional+recovery
Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-baker L (1984) Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 64(1):35–40
Acknowledgements
We would like to thank “Consejo Nacional de Ciencia y Tecnología (CONACYT)”, Universidad Nacional Autónoma de México and the “Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud” for the support during the postgraduate studies of Ms. Berenice Araiza-Nava (CVU 923656) and Ms. Brenda M. Martínez-Hernández. We also would like to thank MSc. Griselda Adriana Cruz Priego for her support with the graphics for this research work.
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BA-N and LM-S developed the review question and the systematic review methodology, were part of the review process and wrote the manuscript; PC and MLP-P contributed in the methodology development and in the preparation of the manuscript; MKJ and MC contributed to the manuscript preparation and the clinical relevance interpretation of the results and discussion, BMM-H contributed as a reviewer and to the discussion as one of our physiotherapy experts; FG-J contributed with the clinical relevance interpretation the results and discussion as our rehabilitation medical expert.
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MKJ has received honoraria and grant support from Amgen, UCB and Kyowa Kirin Hakin outside the development of this manuscript. MC works for International Osteoporosis Foundation. BA-N, LM-S, PC, MLP-P, BMM-H, and FG-J declare that they have no conflicts or competing interests.
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Araiza-Nava, B., Méndez-Sánchez, L., Clark, P. et al. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporos Int 33, 1429–1444 (2022). https://doi.org/10.1007/s00198-022-06346-6
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DOI: https://doi.org/10.1007/s00198-022-06346-6