PRE-FRACTURE FUNCTIONAL LEVEL IS ASSOCIATED WITH BASIC MOBILITY IN THE ACUTE PHASE OF HIP FRACTURE SURGERY IN BRAZILIAN OLDER ADULTS

M. Jacon Peres Ueno¹, L.L. Capato¹, A. Sundin Foltran², G.H. Pelinson², C.F. Pereira da Silva Herrero³, D. L. Orwig⁴, J. Magaziner⁴, D.C. Carvalho de Abreu⁵

¹Ribeirão Preto School of Medicine, University of São Paulo (USP), Program in Rehabilitation and Functional Performance, Ribeirão Preto, Brazil, ²Santa Casa de Misericórdia de Ribeirão Preto, Orthopedics and Hip Surgery, Ribeirão Preto, Brazil, ³Ribeirão Preto Medical School of the University of São Paulo (USP), Orthopedics and Anesthesiology, Ribeirão Preto, Brazil, ⁴University of Maryland School of Medicine, Epidemiology and Public Health, Baltimore, United States, ⁵Ribeirão Preto School of Medicine, University of São Paulo (USP), Health Sciences, Ribeirão Preto, Brazil

Background: The recovery of independence in basic mobility is the first step toward returning to the pre-fracture functional level after hip fracture surgery. The Cumulated Ambulation Score (CAS) is a valid tool to assess basic mobility in patients who suffered a hip fracture and has a strong correlation with 30-day mortality and postoperative medical complications. Although the activities evaluated by CAS are considered minimum criteria for a patient to be discharged from the hospital, in Brazil, especially in public hospitals, the reality seems to be far from what is recommended. Therefore, it is essential to evaluate basic mobility in the acute phase after hip fracture in Brazil.

Purpose: To assess basic mobility after 15 days of hospital discharge and to identify which clinical and physical components are associated with a short-term level of mobility after hip fracture in Brazilian older adults.

Methods: We studied 25 older adults with a mean age of 78 years who were admitted to a public hospital in Ribeirão Preto city, São Paulo State, with a proximal femoral fracture. Personal, clinical and surgical data were collected from medical records. The New Mobility Score (NMS) to assess pre-fracture functional capacity and the Cumulated Ambulation Score (CAS) to assess basic mobility, defined as independence to get in and out of bed, sit and get up from a chair, and walk with or unaided, were collected 15 days after discharge, at the orthopedic outpatient clinic of the same hospital. The association between CAS (dependent variable) and the NMS functional level before fracture, type of surgery, delay in days to surgery and length of hospital stay (independent variables) was performed using multivariate linear regression adjusted for age and years of schooling.

Results: Only 5 patients (20%) achieved complete basic mobility (CAS = 6) after 15 days of discharge, 11 (44%) had difficulty performing at least one basic task, while 10 (40%) did not walk (CAS = 0, for indoor walking). In the linear regression analysis, only NMS pre-fracture functional level showed an association with basic mobility (CAS) in the acute phase of hip fracture surgery (p=0.03). According to the unstandardized coefficient (β), for every 1 point in the NMS, the CAS increases 0.4 points.

Conclusions: Basic mobility was not achieved in most patients evaluated after 15 days of hospital discharge. The activity with the most significant impairment was walking, which may be due to the lack of in-hospital orthogeriatric care. In addition, the NMS functional level before fracture may be useful in predicting basic mobility after 15 days of discharge based on results from this small study showing that the better the previous mobility before hip fracture, the better the basic mobility in the short term.

Implications: Basic intra-hospital mobility should be prioritized in Brazilian public hospitals, in addition, the health care team should pay attention to the patients with low pre-fracture functional level, directing them to an intensive training program to improve the functional outcome after discharge.

Funding acknowledgements: The Teaching, Research and Assistance Support Foundation of Univesity Hospital (FAEPA), Ribeirao Preto Medical School, University of Sao Paulo, Brazil

Keywords:
Hip fracture
Cumulated Ambulation Score
New Mobility Score

Topics:
Musculoskeletal: lower limb
Older people
Orthopaedics

Did this work require ethics approval? Yes

Institution: Centro Universitário Barão de Mauá

Committee: Local Human Research Ethics Committee

Ethics number: CAAE: 45135021.9.0000.5378