Association Between Orthostatic Hypotension and Handgrip Strength With Successful Rehabilitation in Elderly Hip Fracture Patients

doi:10.1016/j.apmr.2016.11.009

Archives of Physical Medicine and Rehabilitation

Volume 98, Issue 8, August 2017, Pages 1544-1550.e3

https://doi.org/10.1016/j.apmr.2016.11.009 Get rights and content

Abstract

Objective

To investigate the relationship between orthostatic hypotension (OH) and muscle strength versus time to successful rehabilitation within elderly patients with hip fracture.

Design

A prospective, observational cohort study. Handgrip strength was measured at the day of admission and OH as soon as possible after surgery. Cox proportional hazard modeling was used to investigate the relationship between OH or handgrip strength (kg) and time to successful rehabilitation, expressed as hazard ratios (HRs). OH was defined as a decrease in systolic blood pressure of ≥20mmHg or diastolic blood pressure of ≥10mmHg after postural change (dichotomous). Handgrip strength was measured with a hand dynamometer (continuous).

Setting

General hospital.

Participants

Patients (N=116) aged ≥70 years with a hip fracture were recruited on the day of hospital admission.

Interventions

Not applicable.

Main Outcome Measures

Primary outcome was time to successful rehabilitation, which was defined as discharge to patients' own homes.

Results

During a median follow-up period of 36 days (interquartile range, 9–57d), 103 patients (89%) were successfully rehabilitated. No statistically significant relationships were found between OH and time to successful rehabilitation (HR=1.05; 95% confidence interval [CI], .67–1.66). Also, handgrip strength and successful rehabilitation were not statistically significantly related (HR=1.03; 95% CI, .99–1.06).

Conclusions

OH measured during the first days of hospitalization is not related to time to successful rehabilitation in patients with hip fracture who have undergone surgery. Although no significant relationship was seen in the present study, the width of the CIs does not exclude a relevant relationship between handgrip strength and time to successful rehabilitation.

Section snippets

Study population

This prospective, observational cohort study was performed in a general hospital (Isala Hospital, Zwolle, The Netherlands). All patients aged ≥70 years who were admitted to the hospital with a hip fracture and treated with surgery were eligible, and most of them were recruited. Some patients could not be recruited because they were admitted during the night.

Recruitment and all study procedures took place between November 2014 and December 2015. Exclusion criteria were having a life expectancy

Results

A total of 116 patients were included in this cohort. The baseline characteristics are presented in table 1. The median age of the total study population was 82 years (IQR, 76–86y). Various surgical techniques were used to treat the hip fractures: 37% intramedullary nail, 50% hemi- or total hip arthroplasty, and 13% (sliding) hip screws. Thirty-nine patients (34%) were discharged to their own homes and 77 patients (66%) to a nursing home facility for further rehabilitation. During a median

Discussion

OH, measured in the immediate postoperative phase, was not related to time to successful rehabilitation in hospitalized elderly with a hip fracture. Although increased muscle strength was not significantly related to time to successful rehabilitation in the present study, the width of the CI does not exclude a relevant relationship between handgrip strength and time to successful rehabilitation. Besides, muscle strength as a confounder, in the model with OH as the variable of interest, was

Conclusions

In conclusion, this study showed that OH measured during the first days of hospitalization was not related to time to successful rehabilitation. Although no significant relationship was seen in the present study, the width of the CI does not exclude a relevant relationship between handgrip strength and time to successful rehabilitation.

Suppliers

a.
A&D UA-767 Plus; A&D Company.
b.
Heine Gamma XXL-T sphygmomanometer; Heine Optotechnik.
c.
Jamar hand dynamometer; Patterson Medical.
d.
SPSS software (version 22); IBM Corp.

Acknowledgment

We thank K.H. Groenier, PhD, for helping with the statistical analyses.

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Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis
2021, Geriatric Nursing
Citation Excerpt :
Seven studies reported multiple factors.4,10,23,24,26–28 In two studies, a single factor was examined.25,29 Twelve factors (i.e. age, Activities of Daily Living [ADL], caregiver, cognition, comorbidities, diagnosis, motor function, nutritional status, oral health problems, race, sex and time from onset) were examined in two or more studies.
Purpose; Returning to community living is an indicator for successful rehabilitation in older adults admitted to geriatric rehabilitation. Predicting successful rehabilitation could contribute to the deployment of early discharge planning, and leads to a more custom-made rehabilitation trajectory. This review aims to present an overview of factors associated with successful rehabilitation following inpatient geriatric rehabilitation.
Method; A systematic literature review was conducted in PubMed, CINAHL and Embase. Extracted factors were analysed via Bakker's five levels of evidence.
Results; Nine studies with methodological quality of good to moderate were included. For 13 of the 18 extracted factors, limited (n=3), moderate (n=5) and conflicting (n=5) evidence found a significant association.
Conclusions; Caregiver, comorbidities, motor-function, nutritional status, time from onset are significantly related to successful rehabilitation. These factors could support healthcare professionals to indicate successful rehabilitation at admission and contributes to deployment of early discharge planning and development of more custom-made rehabilitation trajectories.
Handgrip strength predicts length of stay and quality of life in and out of hospital
2020, Clinical Nutrition
Citation Excerpt :
Handgrip strength (HGS) is a practical measure of overall muscle strength and function [1–7] and has been used by some to indicate frailty [1,8–18].
Handgrip strength (HGS) is a practical measure of strength and physical function that can be used to identify frailty among hospitalized patients, but its utility in this setting is unclear. To be considered useful, any functional measure needs to provide pertinent information on the patient and predict relevant outcomes such as health-care utilization (e.g., length of stay (LOS)) and patient-reported quality of life (QOL). The purpose of this study was to determine if HGS predicted LOS and QOL. A second aim was to examine the best sensitivity (SE) and specificity (SP) for predicting length of stay (>7 or >13 days) using previously published cut-points for HGS.
HGS was measured on 1136 medical patients shortly after admission with a Lafayette dynamometer. QOL was assessed with the self-reported SF-12 completed with an interviewer during hospitalization and 30- days after discharge via telephone. Physical (PCS) and mental (MCS) component scores of SF-12 were calculated. A variety of covariates were assessed (e.g., nutritional status). Multivariate analyses stratified by sex were completed.
The mean LOS was 12.71 days (median = 8.00; SD = 13.20), 12.88 days (SD = 13.82) for males, and 12.58 days (SD = 12.68) for females. Lower admission HGS scores were associated with longer LOS (male X² = 7.85, p < 0.05; female X² = 14.9, p < 0.0001). The average quality of life scores were as follows: in hospital PCS: 34.66, MCS: 46.49; post discharge PCS: 36.17; MCS: 51.22. HGS predicted PCS during hospitalization (male X² = 36.22, p < 0.0001; female X² = 19.87, p < 0.0001) and post hospitalization (male X² = 6.98, p < 0.01; female X² = 10.99, p < 0.01). Various reference cut-points for HGS were tested against LOS, with none being considered appropriate (e.g., SE and SP both < 70) when adjusting for age and sex.
Admission HGS adds predictive value for both LOS and physical components of QOL and is worth pursuing in practice to identify potential frailty and the need for proactive steps to mitigate further functional decline during hospitalization. However, HGS cut-points for LOS specific to acute care patients need to be defined and tested.
Rehabilitation Needs of the Elder with Traumatic Brain Injury
2017, Physical Medicine and Rehabilitation Clinics of North America
Citation Excerpt :
As with cognitive impairments, the clinician should avoid polypharmacy and incorporate a holistic approach to the rehabilitation plan, focusing on nonpharmacologic interventions with medications serving only as adjuvants to decrease symptom burden. Orthostatic hypotension is common in the elderly.41 It is defined as a decrease of 20 mm Hg in the systolic blood pressure and/or decrease of 10 mm Hg in the diastolic blood pressure within 3 minutes of sitting or standing.42

: Supported by the Isala Innovation and Research Fund. The role of the sponsor was solely financial support. The sponsor had no involvement in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

: Disclosures: none.

View full text

Original researchAssociation Between Orthostatic Hypotension and Handgrip Strength With Successful Rehabilitation in Elderly Hip Fracture Patients

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Study population

Results

Discussion

Conclusions

Suppliers

Acknowledgment

Injury

Accid Anal Prev

Arch Phys Med Rehabil

Injury

Arch Gerontol Geriatr

Arch Gerontol Geriatr

J Am Med Dir Assoc

Arch Phys Med Rehabil

J Am Soc Hypertens

J Am Coll Cardiol

Int J Surg

J Am Med Dir Assoc

Functional results after treatment of hip fracture: a multicentre, prospective study in 215 patients

Eur J Surg

The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review

J Geriatr Phys Ther

Handgrip strength is an independent predictor of functional outcome in hip-fracture women: a prospective study with 6-month follow-up

Medicine (Baltimore)

Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people

Psychol Med

Handgrip strength but not appendicular lean mass is an independent predictor of functional outcome in hip-fracture women: a short-term prospective study

Arch Phys Med Rehabil

Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities

BMC Geriatr

Functional independence in late-life: maintaining physical functioning in older adulthood predicts daily life function after age 80

J Gerontol A Biol Sci Med Sci

Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established Populations for Epidemiologic Studies of the Elderly

Am J Public Health

Frailty in older adults: evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis

J Hypertens

Original research
Association Between Orthostatic Hypotension and Handgrip Strength With Successful Rehabilitation in Elderly Hip Fracture Patients