Department of Rehabilitation, Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan.
Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan.
Physiother Res Int. 2024 Jan;29(1):e2070. doi: 10.1002/pri.2070.
Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence.
This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65 years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity.
The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135 s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76).
The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.
髋部骨折与日常生活活动（ADL）能力下降有关，需要长期护理。髋部骨折患者的身体活动在手术后立即暂时受损，导致在康复入院时难以测量身体活动。本研究通过确定预测 ADL 独立性的截止值，来检验出院时的 ADL 与康复入院时的轻至中度体力活动之间的关系。
本回顾性病例对照研究分析了 43 例年龄≥65 岁的术后髋部骨折患者，这些患者入住住院康复病房。出院时的 ADL 使用功能性独立测量运动项目（FIM-m）进行评估。使用配备加速度计的活动追踪器测量康复入院时的身体活动持续时间。在院外使用临床虚弱量表评估虚弱程度。使用斯皮尔曼等级相关系数检验这些变量之间的关系。使用协方差分析检验需要和不需要 ADL 帮助的患者之间的身体活动差异。从身体活动的持续时间构建预测出院时需要 ADL 帮助的接受者操作特征曲线。
康复入院时的身体活动持续时间与出院时的 FIM-m 相关。预测出院时需要 ADL 帮助的身体活动持续时间的截止值为 135 秒，其灵敏度为 83.3%，特异性为 68.4%（曲线下面积：0.76）。
康复入院时的身体活动持续时间可能是一个可以定量预测老年髋部骨折患者出院时需要 ADL 帮助的风险因素。轻至中度强度体力活动的持续时间可能是改善患者 ADL 的多学科住院康复的一个组成部分。
