Factors influencing the early post-operative functional outcome in elderly patients with a hip fracture.

Abstract

Background: Hip fractures are among the most common causes of disability and hospitalisation in the elderly. Currently there are no studies available in South Africa that determine the factors that influence the early post-operative functional outcome in elderly patients with a hip fracture.Aim: To establish the factors influencing the early post-operative functional outcome in elderly patients with a hip fracture.

Methodology: A prospective pre-test post-test observational study design was used. Consecutive sampling was used to recruit participants (n=72). Assessments were conducted pre-operatively, at discharge and six weeks post discharge at two public health care hospitals in Johannesburg, South Africa. Pre-operatively the pre-fracture functional mobility of the participants was determined using the New Mobility Score (NMS), the presence of pre-existing co-morbidities was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the cognitive function was assessed using the Six-Item Cognitive Impairment Test (6CIT). At discharge and at six weeks post discharge the participants post-operative functional level was assessed using the Elderly Mobility Scale (EMS) and the Lower Extremity Functional Scale (LEFS). A multiple regression analysis was used to determine associations. The study was set at p = 0.05 level of significance and 95% confidence interval (CI).

Results: Participants were generally independent with pre-fracture mobility at baseline and presented with approximately three pre-existing co-morbidities. The presence of cognitive impairments in the participants decreased during the duration of the study, while the post-operative functional level in this population improved. Pre-fracture functional level was strongly related to and also the strongest predictor of post-operative functional outcome. The presence of co-morbidities and impaired cognitive function were also indirectly related.

Conclusion: Pre-fracture functional mobility was found to be the strongest determinant of post-operative functional outcome, followed by cognitive function and the presence of pre-existing co-morbidities. By ensuring that these factors are optimal prior to sustaining a hip fracture, elderly patients are more likely to have better outcomes. For those patients who do sustain a hip fracture, intensive rehabilitation is especially necessary for the patient who presents with poor pre-fracture mobility, impaired cognition and pre-existing medical co-morbidities.