Recovery From Hip Fracture in Eight Areas of Function

TLDR

The study examines changes in eight functional domains after hip fracture, identifies when maximal recovery occurs in each, and evaluates the sequence of recovery across domains. A prospective cohort of 674 community‑residing hip‑fracture patients from eight Baltimore hospitals was followed for two years, with eight functional areas assessed by interview and observation at 2, 6, 12, 18, and 24 months and recovery trajectories modeled using generalized estimating equations. Recovery varied by domain, with new dependence ranging from 20.3% for putting on pants to 89.9% for climbing stairs, and time to maximal recovery spanning 3.9 to 11.2 months, indicating significant disability but an orderly sequence of functional improvement. Methods were described.

Abstract

This report describes changes in eight areas of functioning after a hip fracture, identifies the point at which maximal levels of recovery are reached in each area, and evaluates the sequence of recuperation across multiple functional domains. METHODS. Community-residing hip fracture patients (n = 674) admitted to eight hospitals in Baltimore, Maryland, 1990-1991 were followed prospectively for 2 years from the time of hospitalization. Eight areas of function (i.e., upper and lower extremity physical and instrumental activities of daily living; gait and balance; social, cognitive, and affective function) were measured by personal interview and direct observation during hospitalization at 2, 6, 12, 18, and 24 months. Levels of recovery are described in each area, and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data.Most areas of functioning showed progressive lessening of dependence over the first postfracture year, with different levels of recovery and time to maximum levels observed for each area. New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3% for putting on pants to as high as 89.9% for climbing five stairs. Recuperation times were specific to area of function, ranging from approximately 4 months for depressive symptoms (3.9 months), upper extremity function (4.3 months), and cognition (4.4 months) to almost a year for lower extremity function (11.2 months).Functional disability following hip fracture is significant, patterns of recovery differ by area of function, and there appears to be an orderly sequence by which areas of function reach their maximal levels.