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Functional Outcomes of Fragility Fracture Integrated Rehabilitation Management in Sarcopenic Patients after Hip Fracture Surgery and Predictors of Independent Ambulation

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To compare the changes in the functional level of patients with versus without sarcopenia who received by fragility fracture integrated rehabilitation management (FIRM) after hip fracture (HF) surgery over a 6-month follow-up period and to identify variables influencing independent ambulation (IA) at 6 months after HF.

Design

Prospective observational study.

Setting

Three in-hospital rehabilitation setting.

Participants

Patients older than 65 years of age (N=80) categorized by the presence of sarcopenia.

Intervention

The FIRM program during the-2 week hospital stay after surgery.

Measurements

Main outcomes for ambulatory function (Koval score, Functional Ambulatory Category) and other secondary outcomes were measured at rehabilitation admission, at discharge, at 3 months and 6 months after surgery. Other secondary outcomes were measured. The possibility of IA at 6 months after surgery were also investigated.

Results

Sarcopenia and non-sarcopenia patients did not differ significantly in terms of changes in ambulation or other functions over a 6-month follow-up (p < 0.001 or p = 0.001). The two groups did not differ significantly in terms of final functional status (6 months). The IA ratios of the two groups did not significantly differ at 6 months after surgery (sarcopenia [54.3%] and non-sarcopenia [64.5%]). IA before fracture (p = 0.039) and age (≥80 years) (p = 0.03) were independent predictors and sarcopenia was not a predictor for the possibility of IA at 6-months after surgery.

Conclusions

The FIRM program was effective for promoting functional recovery in older patients with fragility HF, either with or without sarcopenia. The present findings provide evidence of the pressing need for integrated rehabilitation management in fragility fracture care to improve functional recovery in patients with sarcopenia.

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References

  1. Elliott J, Beringer T, Kee F, et al. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol. 2003;56(8):788–795. doi: https://doi.org/10.1016/S0895-4356(03)00129-X

    Article  CAS  Google Scholar 

  2. Dyer SM, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16(1):158. doi: https://doi.org/10.1186/s12877-016-0332-0

    Article  Google Scholar 

  3. Beaupre LA, Cinats JG, Senthilselvan A, et al. Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway. Qual Saf Health Care. 2006;15(5):375–379. doi: https://doi.org/10.1136/qshc.2005.017095

    Article  CAS  Google Scholar 

  4. Koval KJ, Cooley MR. Clinical pathway after hip fracture. Disabil Rehabil. 2005;27(18–19):1053–1060. doi: https://doi.org/10.1080/09638280500056618

    Article  Google Scholar 

  5. Lee SY, Beom J, Kim BR, et al. Comparative effectiveness of fragility fracture integrated rehabilitation management for elderly individuals after hip fracture surgery: A study protocol for a multicenter randomized controlled trial. Medicine (Baltimore). 2018;97(20):e10763. doi: https://doi.org/10.1097/MD.0000000000010763

    Article  Google Scholar 

  6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–423. doi: https://doi.org/10.1093/ageing/afq034

    Article  Google Scholar 

  7. Landi F, Calvani R, Cesari M, et al. Sarcopenia as the Biological Substrate of Physical Frailty. Clin Geriatr Med. 2015;31(3):367–374. doi: https://doi.org/10.1016/j.cger.2015.04.005

    Article  Google Scholar 

  8. Landi F, Calvani R, Ortolani E, et al. The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int. 2017;28(5):1569–1576. doi: https://doi.org/10.1007/s00198-017-3929-z

    Article  CAS  Google Scholar 

  9. Gonzalez-Montalvo JI, Alarcon T, Gotor P, et al. Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int. 2016;16(9):1021–1027. doi: https://doi.org/10.1111/ggi.12590

    Article  Google Scholar 

  10. Steihaug OM, Gjesdal CG, Bogen B, et al. Does sarcopenia predict change in mobility after hip fracture? a multicenter observational study with one-year follow-up. BMC Geriatr. 2018;18(1):65. doi: https://doi.org/10.1186/s12877-018-0755-x

    Article  Google Scholar 

  11. Lim S-K, Lee SY, Beom J, et al. Comparative outcomes of inpatient fragility fracture intensive rehabilitation management (FIRM) after hip fracture in sarcopenic and non-sarcopenic patients: a prospective observational study. European Geriatric Medicine. 2018;9(5):641–650. doi: https://doi.org/10.1007/s41999-018-0089-4

    Article  Google Scholar 

  12. Morandi A, Onder G, Fodri L, et al. The Association Between the Probability of Sarcopenia and Functional Outcomes in Older Patients Undergoing In-Hospital Rehabilitation. J Am Med Dir Assoc. 2015;16(11):951–956. doi: https://doi.org/10.1016/j.jamda.2015.05.010

    Article  Google Scholar 

  13. Roffman CE, Buchanan J, Allison GT. Charlson Comorbidities Index. J Physiother. 2016;62(3):171. doi: https://doi.org/10.1016/j.jphys.2016.05.008

    Article  Google Scholar 

  14. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101. doi: https://doi.org/10.1016/j.jamda.2013.11.025

    Article  Google Scholar 

  15. Lukaski HC, Johnson PE, Bolonchuk WW, et al. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. The American journal of clinical nutrition. 1985;41(4):810–817. doi: https://doi.org/10.1093/ajcn/41.4.810

    Article  CAS  Google Scholar 

  16. Coppini LZ, Waitzberg DL, Campos AC. Limitations and validation of bioelectrical impedance analysis in morbidly obese patients. Curr Opin Clin Nutr Metab Care. 2005;8(3):329–332. doi: https://doi.org/10.1097/01.mco.0000165013.54696.64

    Article  Google Scholar 

  17. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23(6):1430–1453. doi: https://doi.org/10.1016/j.clnu.2004.09.012

    Article  Google Scholar 

  18. Koval KJ, Skovron ML, Aharonoff GB, et al. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res. 1995(310):150–159.

  19. Holden MK, Gill KM, Magliozzi MR, et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984;64(1):35–40. doi: https://doi.org/10.1093/ptj/64.1.35

    Article  CAS  Google Scholar 

  20. Lennon S, Johnson L. The modified rivermead mobility index: validity and reliability. Disabil Rehabil. 2000;22(18):833–839. doi: https://doi.org/10.1080/09638280050207884

    Article  CAS  Google Scholar 

  21. Berg K, Wood-Dauphine S, Williams J, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304–311. doi: https://doi.org/10.3138/ptc.41.6.304

    Article  Google Scholar 

  22. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997;15(2):300–308.

    Google Scholar 

  23. Jung IK, Kwak DI, Joe SH, et al. A study of standardization of Korean form of Geriatric Depression Scale (KGDS). J Korean Geriatr Psychiatry. 1997;1(1):61–72.

    Google Scholar 

  24. Group E. EuroQol-a new facility for the measurement of health-related quality of life. Health policy. 1990;16(3):199–208.

    Article  Google Scholar 

  25. Jung HY, Park BK, Shin HS, et al. Development of the Korean version of Modified Barthel Index (K-MBI): multi-center study for subjects with stroke. J Korean Acad Rehabil Med. 2007;31(3):283–297.

    Google Scholar 

  26. Won CW, Yang KY, Rho YG, et al. The development of Korean activities of daily living (K-ADL) and Korean instrumental activities of daily living (K-IADL) scale. J Korean Geriatr Soc. 2002;6(2):107–120.

    Google Scholar 

  27. Jung HW, Yoo HJ, Park SY, et al. The Korean version of the FRAIL scale: clinical feasibility and validity of assessing the frailty status of Korean elderly. Korean J Intern Med. 2016;31(3):594–600. doi: https://doi.org/10.3904/kjim.2014.331

    Article  Google Scholar 

  28. Lee DY, Lee KU, Lee JH, et al. A normative study of the CERAD neuropsychological assessment battery in the Korean elderly. J Int Neuropsychol Soc. 2004;10(1):72–81. doi: https://doi.org/10.1017/S1355617704101094

    Article  Google Scholar 

  29. Tang VL, Sudore R, Cenzer IS, et al. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med. 2017;32(2):153–158. doi: https://doi.org/10.1007/s11606-016-3848-2

    Article  Google Scholar 

  30. Magaziner J, Fredman L, Hawkes W, et al. Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol. 2003;157(11):1023–1031. doi: https://doi.org/10.1093/aje/kwg081

    Article  Google Scholar 

  31. Bachmann S, Finger C, Huss A, et al. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340:c1718. doi: https://doi.org/10.1136/bmj.c1718

    Article  Google Scholar 

  32. Kristensen MT, Foss NB, Ekdahl C, et al. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop. 2010;81(3):296–302. doi: https://doi.org/10.3109/17453674.2010.487240

    Article  Google Scholar 

  33. Hirose J, Ide J, Yakushiji T, et al. Prediction of postoperative ambulatory status 1 year after hip fracture surgery. Arch Phys Med Rehabil. 2010;91(1):67–72. doi: https://doi.org/10.1016/j.apmr.2009.09.018

    Article  Google Scholar 

  34. Ishida Y, Kawai S, Taguchi T. Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures. Clin Orthop Relat Res. 2005;https://doi.org/10.1097/01.blo.0000159156.40002.30(436):208–215. doi: https://doi.org/10.1097/01.blo.0000159156.40002.30

    Article  Google Scholar 

  35. Svensson O, Stromberg L, Ohlen G, et al. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br. 1996;78(1):115–118. doi: https://doi.org/10.1302/0301-620X.78B1.0780115

    Article  CAS  Google Scholar 

  36. Savino E, Martini E, Lauretani F, et al. Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med. 2013;126(12):1068–1075 e1061. doi: https://doi.org/10.1016/j.amjmed.2013.04.017

    Article  Google Scholar 

  37. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;https://doi.org/10.1002/14651858.CD001708.pub2(4):CD001708. doi: https://doi.org/10.1002/14651858.CD001708.pub2

    Google Scholar 

  38. Yoo JI, Ha YC, Lim JY, et al. Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis. J Korean Med Sci. 2017;32(5):858–867. doi: https://doi.org/10.3346/jkms.2017.32.5.858

    Article  Google Scholar 

  39. Kristensen MT, Bandholm T, Bencke J, et al. Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture. Clin Biomech (Bristol, Avon). 2009;24(2):218–224. doi: https://doi.org/10.1016/j.clinbiomech.2008.10.003

    Article  Google Scholar 

  40. Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990;45(3):M101–107. doi: https://doi.org/10.1093/geronj/45.3.M101

    Article  CAS  Google Scholar 

  41. Heikkinen T, Jalovaara P. Four or twelve months’ follow-up in the evaluation of functional outcome after hip fracture surgery? Scand J Surg. 2005;94(1):59–66. doi: https://doi.org/10.1177/145749690509400115

    Article  CAS  Google Scholar 

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Acknowledgements

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Number: HC15C1189).

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea

    S.-K. Lim

  2. Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea

    J. Beom

  3. Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea

    S. Y. Lee

  4. Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Jae-Young Lim

  5. Institute on Aging, Seoul National University, Seoul, Republic of Korea

    Jae-Young Lim

  6. Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea, 13620

    Jae-Young Lim

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Correspondence to Jae-Young Lim.

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Conflict of interest: The authors have no conflicts of interest to disclose.

Ethical standards: This study was approved by the Institutional Review Boards of Seoul National University Bundang Hospital (B-1603-337-002), Chung-Ang University Hospital (C2016117[1860]), and Jeju National University Hospital (JEJUNUH 2016-11-001), and written informed consent was obtained from all participants.

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Lim, SK., Beom, J., Lee, S.Y. et al. Functional Outcomes of Fragility Fracture Integrated Rehabilitation Management in Sarcopenic Patients after Hip Fracture Surgery and Predictors of Independent Ambulation. J Nutr Health Aging 23, 1034–1042 (2019). https://doi.org/10.1007/s12603-019-1289-4

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  • DOI: https://doi.org/10.1007/s12603-019-1289-4

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