School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Arch Phys Med Rehabil. 2018 Jun;99(6):1108-1115. doi: 10.1016/j.apmr.2018.01.022. Epub 2018 Feb 14.
To examine the course of recovery and resulting health-related quality of life (HRQL) after low-trauma hip fracture using 2 different definitions of recovery.
Inception cohort with 8 assessments over 1 year.
Participants were recruited from a tertiary-care hospital and followed up in the community.
Community-dwelling hip fracture patients (N=47, 75% of all eligible; aged ≥65y).
Not applicable.
Prefracture functional level was used to identify subgroups of participants with similar trajectories of mobility over time. Recovery in functional mobility was defined in 2 ways: the "traditional" definition (return to prefracture level of functional mobility) and a "targeted recovery" definition (ability to climb 10 steps). Both were measured using the Lower Extremity Functional Scale. HRQL was measured using the RAND 36-Item Short-Form Health Survey.
Participants were categorized into 3 subgroups with: low, medium, and high prefracture functional abilities. Agreement between the 2 definitions of recovery (quantified using κ coefficient) was strong for the medium group (.81; 95% confidence interval, .56-1.00), weak for the high group (.46; 95% confidence interval, 0.0-.99), and minimal for the low group (.12; 95% confidence interval, 0.0-.328). Contrary to the traditional definition, patients who achieved targeted recovery had statistically and clinically better HRQL than the rest of the cohort throughout the study (estimated average difference of 10.8 points on RAND 36-Item Short-Form Health Survey; 95% confidence interval, 6.67-15.07).
The agreement between the 2 definitions of recovery ranged from minimal to strong according to patient group. Using a functional target to define recovery predicted HRQL better. It is vital to consider the definition of recovery carefully for research or clinical practice because it can influence subsequent decisions (eg, endorsing a specific intervention or discharging patients).
使用两种不同的恢复定义来检查低创伤性髋部骨折后恢复的过程和由此导致的健康相关生活质量（HRQL）。
为期 1 年的起点队列，共进行 8 次评估。
参与者从三级保健医院招募，并在社区进行随访。
居住在社区的髋部骨折患者（N=47，所有符合条件的患者的 75%；年龄≥65 岁）。
不适用。
使用骨折前的功能水平来确定具有相似时间内移动轨迹的参与者亚组。功能性移动的恢复通过以下两种方式定义：“传统”定义（恢复到骨折前的功能性移动水平）和“目标恢复”定义（能够爬上 10 个台阶）。两者均使用下肢功能量表进行测量。使用 RAND 36-Item Short-Form Health Survey 测量 HRQL。
根据骨折前的功能能力，参与者被分为低、中、高 3 个亚组。对于中等组，两种恢复定义之间的一致性（用κ系数量化）较强（.81；95%置信区间，.56-1.00），对于高组较弱（.46；95%置信区间，0.0-.99），对于低组最小（.12；95%置信区间，0.0-.328）。与传统定义相反，在整个研究过程中，达到目标恢复的患者在 HRQL 方面具有统计学和临床意义上的显著优势，比队列中的其他患者高出 10.8 分（RAND 36-Item Short-Form Health Survey 的估计平均差异；95%置信区间，6.67-15.07）。
根据患者群体，两种恢复定义之间的一致性从最小到强不等。使用功能目标来定义恢复可更好地预测 HRQL。在研究或临床实践中，仔细考虑恢复的定义非常重要，因为它会影响后续决策（例如，支持特定干预措施或出院患者）。
