MOBILITY AND MUSCLE STRENGTH AFTER HIP FRACTURE

¹Diakonhjemmet Hospital, Oslo, Norway

Background: Hip fractures are associated with reduced function and increased mortality, dependency and need for institutional care. In addition, the economic costs are substantial. Accordingly, there is a need for studies aiming to improve the quality of treatment for this population.

Purpose: The study aimed to investigate changes in mobility and muscle strength (grip strength and knee-extension strength) in home dwelling older people at three months following a hip fracture.

Methods: The study was based on data from patients recruited between July 2012 - December 2013 from Diakonhjemmet Hospital in Oslo, Norway who were participants in the Sarcopenia In Hip Fracture Study, a prospective, multicentre observational study of older people following a hip fracture. To be eligible for inclusion the patients had to be aged 65 years or older, able to walk unassisted (walking aid permitted), and to give informed consent. Patients were considered ineligible if they lived permanently in a nursing home, if they were medically unstable or had a life expectancy of less than three months. All patients received standard rehabilitation. Data were collected by physicians, research nurses and physical therapists. Baseline measurements were taken the day before discharge and follow-up three months later. Mobility was measured by the New Mobility Score (NMS). Grip strength was measured by a Jamar hydraulic dynamometer (Lafayette Instrument Company, USA). Knee-extension strength in the non-fractured leg was measured by a Chattilon hand-held dynamometer. All statistical analyses were performed with the IBM SPSS Statistics version 17. A two-tailed t-test was used to analyse results and p-value 0.05 was considered statistically significant.

Results: A total of 651 patients with a hip fracture were admitted to Diakonhjemmet Hospital and operated on during the recruitment period. 80 patients were included in the Sarcopenia In Hip Fracture Study, complete data were obtained for 48 of them. Their mean age was 77.6±7.6 years, 77% were female. Mean NMS before the fracture was 8.2±1.5 points. Mean baseline grip strength was 24.9±9.8 kg, and mean baseline knee-extension strength was 197.1±60.8 Newton. Mean NMS at three months follow-up was 5.9±2.0 points. Mean grip strength at three months follow-up was 22.8±9.8 kg, and mean knee-extension strength at three months follow-up was 203.0±58.8 Newton. There was a significant reduction in mobility (p ≤ 0.001) and grip strength (p = 0.011) at three months follow-up compared to baseline scores. There was no significant difference in knee-extension strength in the non-fractured leg (p = 0.393). There was no significant differences at baseline between the 48 patients with complete data and the 32 patients with incomplete data.

Conclusion(s): There was a significant reduction in mobility and grip strength three months following a hip fracture.

Implications: The results from the study show that these patients, who were highly functioning prefracture, had their mobility severely compromised at three months following a hip fracture. Hence, patients with hip fractures are in need of more intensive rehabilitation, and they will probably also benefit from rehabilitation that exceeds three months. Studies that aim to improve early rehabilitation of patients suffering from hip fractures should be established.

Funding acknowledgements: None.

Topic: Older people

Ethics approval: The Sarcopenia In Hip Fracture Study was approved by the Regional Committee on Medical and Health Research Ethics.

All authors, affiliations and abstracts have been published as submitted.