Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: a 1-year prospective cohort study.

OBJECTIVES

To investigate the predictors of functional outcome and changes in the basic activities of daily living in older adults who sustained hip fractures, considering the level of ambulatory ability before injury.

DESIGN

A prospective observational cohort study.

SETTING

One university hospital and 13 community teaching hospitals.

PATIENTS

A consecutive cohort of 650 patients who underwent surgery for a hip fracture between December 2004 and January 2006.

MAIN OUTCOME MEASURES

Recovery of ambulatory ability and independence in activities of daily living 6 and 12 months after surgery.

RESULTS

Ambulatory ability recovered to the prefracture level in approximately half of the patients 6 months after surgery, and those ratios changed little in the next 6 months. In patients who were community ambulators before fractures, the independence in bathing before fractures was a strong predictor of ambulatory ability after surgery, but this was not the case in the former household ambulator group. The attainment of assisted ambulation with a walking cane at hospital discharge was a reliable predictor of ambulatory ability in both former community ambulator and household ambulator groups.

CONCLUSIONS

Ambulatory ability after hip fractures was considered to be determined within 6 months after surgery. There was some difference in prognostic factors for ambulatory ability according to the level of mobility before fractures. The attainment of single cane (T-cane) gait at hospital discharge can serve as a reliable predictor of ambulatory ability after fractures, irrespective of the level of mobility before the injury.

LEVEL OF EVIDENCE

Prognostic Level I. See page 128 for a complete description of levels of evidence.