Toward a meaningful definition of recovery after hip fracture: Comparing two definitions for community-dwelling older adults

Publication date: Available online 14 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mohammad Auais, Suzanne N. Morin, Lois Finch, Sara Ahmed, Nancy Mayo
ObjectivesTo examine the course of recovery and resulting health-related quality of life (HRQL) after low-trauma hip fracture using two different definitions of recovery.DesignInception cohort with eight assessments over one year.SettingParticipants were recruited from a tertiary-care hospital and followed in the community.InterventionNot applicableParticipants47 (75% of all eligible) community-dwelling hip fracture patients (≥65 years).Main Outcome MeasuresPre-fracture functional level was used to identify subgroups of participants with similar trajectories of mobility over time. Recovery in functional mobility was defined in two ways: the "traditional" definition (return to pre-fracture level of functional mobility) and a "targeted recovery" definition (ability to climb 10 steps); both were measured using the Lower Extremity Functional Scale. HRQL was measured using the RAND-36.ResultsParticipants were categorized into three subgroups: low, medium, and high pre-fracture functional abilities. Agreement between the two definitions of recovery (quantified using Kappa coefficient) was strong for the medium group (0.81; 95% CI: 0.56-1.00), weak for the high group (0.46; 95% CI: 0.0-0.99), and minimal for the low group (0.12; 95% CI: 0.0-0.328).Contrary to the traditional definition, patients who achieved targeted recovery had statistically and clinically better HRQL than the rest of the cohort throughout the study (estimated average difference =10.8 points on RAND-36; 95% CI: 6.67-15.07).ConclusionThe agreement between the two definitions of recovery ranged from minimal to strong according to patient group. Using a functional target to define recovery predicted HRQL better. It is vital to consider the definition of recovery carefully for research or clinical practice because it can influence subsequent decisions (e.g. endorsing a specific intervention or discharging patients).



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