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Taylor N1,2, Prendergast L1, Thompson A2, Peiris C1, Hau R2, Harding K2, Shields N1
1La Trobe University, Bundoora, Australia, 2Eastern Health, Box Hill, Australia
Background: Hip fracture is a common and serious fracture affecting older adults that is characterised by difficulty returning to previous levels of function. The health benefits of physical activity are widely reported, however, in the early stages after hip fracture, people complete very little physical activity. Considering the health benefits, adequate levels of physical activity may play a role in restoring physical function following hip fracture.
Purpose: To describe physical activity levels and identify if physical activity is predictive of positive changes in physical function after hip fracture.
Methods: Using an observational cross-sectional design, 57 participants recovering from hip fracture (mean age 80 years, 68% women) were recruited after discharge home. Measures of physical activity (activPAL accelerometer) and physical function [Functional Independence Measure (FIM), the De Morton Mobility Index (DEMMI) and the Frenchay Activity Index (FAI)] were taken at baseline (mean145 days post fracture), and 3 months later. Secondary variables included walking confidence (Ambulatory Self-Confidence Questionnaire) and quality of life. Stepwise (forward and backward) variable selection methods were used to choose a subset of predictors to avoid over-fitting. We used the Akaike Information Criterion (AIC) to determine the best predictors to retain in the model.
Results: Participants at baseline averaged 4,439 steps daily and levels of moderate to vigorous physical activity (≥100 steps/minute) were very low (mean 3.5 minutes daily). There were small, statistically significant increases in all measures of physical function from baseline to 3 months. A lower baseline FIM score, a greater amount of time walking/stepping, and increased walking confidence were independent predictors of change in FIM score from baseline to 3 months (adjusted R2 = 24%). The predicted increase in FIM score per minute increase in daily time walking was 0.097 [95% CI = (0.022, 0.172)], suggesting every additional 15 minutes walking at baseline was associated with an increase in FIM of 1.5 units over the following 3 months. A change of 1.5 units in the FIM is considered trivial relative to the scale range of 18 to 126 units. Other measures of physical activity were not predictive of the change in FIM, DEMMI or FAI. Walking confidence was an independent predictor of change in FIM total and the FIM mobility subscale.
Conclusion(s): Level of physical activity for people discharged home after hip fracture remained low up to 8 months after fracture and had little or no association with change in physical function. Walking confidence may be a stronger predictor of improved physical function after hip fracture than physical activity.
Implications: Level of physical activity for people discharged home after hip fracture remained low up to 8 months after fracture and had little or no association with change in physical function. Walking confidence may be a stronger predictor of improved physical function after hip fracture than physical activity.
Keywords: Physical activity, Hip fracture, Physical function
Funding acknowledgements: A collaborative grant between Eastern Health Foundation and the Research Focus Area of Sport, Exercise and Rehabilitation, La Trobe University.
Purpose: To describe physical activity levels and identify if physical activity is predictive of positive changes in physical function after hip fracture.
Methods: Using an observational cross-sectional design, 57 participants recovering from hip fracture (mean age 80 years, 68% women) were recruited after discharge home. Measures of physical activity (activPAL accelerometer) and physical function [Functional Independence Measure (FIM), the De Morton Mobility Index (DEMMI) and the Frenchay Activity Index (FAI)] were taken at baseline (mean145 days post fracture), and 3 months later. Secondary variables included walking confidence (Ambulatory Self-Confidence Questionnaire) and quality of life. Stepwise (forward and backward) variable selection methods were used to choose a subset of predictors to avoid over-fitting. We used the Akaike Information Criterion (AIC) to determine the best predictors to retain in the model.
Results: Participants at baseline averaged 4,439 steps daily and levels of moderate to vigorous physical activity (≥100 steps/minute) were very low (mean 3.5 minutes daily). There were small, statistically significant increases in all measures of physical function from baseline to 3 months. A lower baseline FIM score, a greater amount of time walking/stepping, and increased walking confidence were independent predictors of change in FIM score from baseline to 3 months (adjusted R2 = 24%). The predicted increase in FIM score per minute increase in daily time walking was 0.097 [95% CI = (0.022, 0.172)], suggesting every additional 15 minutes walking at baseline was associated with an increase in FIM of 1.5 units over the following 3 months. A change of 1.5 units in the FIM is considered trivial relative to the scale range of 18 to 126 units. Other measures of physical activity were not predictive of the change in FIM, DEMMI or FAI. Walking confidence was an independent predictor of change in FIM total and the FIM mobility subscale.
Conclusion(s): Level of physical activity for people discharged home after hip fracture remained low up to 8 months after fracture and had little or no association with change in physical function. Walking confidence may be a stronger predictor of improved physical function after hip fracture than physical activity.
Implications: Level of physical activity for people discharged home after hip fracture remained low up to 8 months after fracture and had little or no association with change in physical function. Walking confidence may be a stronger predictor of improved physical function after hip fracture than physical activity.
Keywords: Physical activity, Hip fracture, Physical function
Funding acknowledgements: A collaborative grant between Eastern Health Foundation and the Research Focus Area of Sport, Exercise and Rehabilitation, La Trobe University.
Topic: Disability & rehabilitation; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: Eastern Health
Ethics committee: Eastern Health Human Research Ethics Committee
Ethics number: LR59/2016
All authors, affiliations and abstracts have been published as submitted.
