Prognostic factors that predict functional outcome after hip fracture

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DESCRIPTION (provided by applicant): Hip fracture is a significant public health concern because of its prevalence, financial costs, and serious medical consequences. Even after a successful surgery, 53.3% of persons are reported to fall again and one out of five people who sustain a hip fracture will die by the end of the first year following the fracture. Although improvements in acute care management are being realized, survivors of hip fracture experience loss of functional ability, which leads to a sequence of events that ends in excess disability (greater than that expected with aging) in many areas of physical function. Early home physical therapy focuses on teaching patients to compensate by altering or adapting a new strategy to achieve independent functioning, rather than restoring function of the involved lower extremity. This asymmetry may lead to further decline in strength and balance and future falls. Clinical indicators that are patient-specific and accurately predict who is most likely to benefit from restorative care do not exist. A novel approach using force platform variables to measure asymmetry between the involved and uninvolved sides during a sit to stand task may be useful alone, or when combined with clinical variables, in predicting physical function and falls following hip fracture. This will be a prospective cohort study using discharge from rehabilitation as an inception point. Data collected at inception will include unique biomechanical measures and clinical measures amenable to restorative care. Six months post hip fracture, when patients typically plateau in their physical abilities, the primary outcome will be self-report of function. This study will be useful in identifying prognostic factors at discharge from physical therapy and for profiling subgroups of patients that will benefit from a program of restorative care. PUBLIC HEALTH RELEVANCE: Hip fracture is a significant public health concern because of its prevalence, financial costs, and serious medical consequences. Following hip fracture, patients receive physical therapy interventions that teach them how to compensate by altering or adapting a new strategy to achieve independent functioning. The goal of this proposal is to identify which patients will benefit from restorative care to improve function and reduce falls risks in patients following hip fracture.