Describing early functional status after hip fracture and total hip arthroplasty.

Overview

Status: Not yet recruiting
Keywords: hip fracture , hip replacement , mobility , strength , older adult , orthopedic , sit-to-stand
IRB Number: 00069454
Specialty: Physical Therapy
Sub Specialties:

Brief Summary

Our overall goal is to target enhanced rehabilitation to those individuals who are most in need after a hip fracture--regardless of fixation method (i.e. including hip replacement as method of repair).  Baseline functional status of patients after hip fracture and surgery has not been documented. This is critical information if we are to determine who might be the best candidates for rehabilitation and to document changes that occur after initial hospitalization. We are especially concerned with the asymmetries in lower extremity force production that occur in the simple task of going from a sitting to standing position, as these asymmetries have been shown to persist several months after surgery and also to be associated with poor long term outcomes.  

Aim 1:    Our primary aim is to quantify and document patient performance of a sit-to-stand task early after hip surgery for a hip fracture (within 72hr), and at approximately 2wk s/p surgery.

  1. We will describe movement patterns and force output in a sit-to-stand task early after hip surgery and compare this to age-matched controls.
  2. We will compare movement pattern asymmetry acutely with 2 weeks later to determine changes during the initial phase of usual care.

Aim 2:  We will gather baseline information on self-reported health with the general health survey (SF-36), and a hip fracture specific self-report measure (Lower Extremity Measure) to describe patient’s initial impression of their health status following hip surgery, and any early changes in their perception of health status with usual care.

Aim 3:  We will quantify mobility function with the timed up and go (TUG) and usual gait speed tests (4 meter walk), and isometric quadriceps muscle strength at discharge from hospital and at 2 weeks s/p discharge.  

Detailed Description

There is currently little documentation on functional mobility in the first two weeks after injury and hospitalizaion in older hip fracture and total hip arthroplasty recipients. Both short-term and long-term outcomes among hip surgery recipients are frequently poor. Hip fracture is cited as the most frequent, costly, and devastating non-lethal injury from a fall. Though nearly 30% of hip fracture recipients expire within one year of incurring injury, 70% survive. Among the survivors, nearly 50% will continue to use an assistive device for the rest of their lives. Less than one in four survivors regain their prior function level; leaving the patient with a lifetime of limited mobility and decreasing ability to maintain independence in daily tasks. Movement patter asymmetries are evident months and even years after hip fracture regardless of surgical fixation method. However, there is little information on how asymmetrical movement patterns develop and their functional effect in this population. Movement and force asymmetries in other aging populations are associated with increased fall risk and less independence with mobility. Some orthopedic studies have cited injury recurrence and likelihood of surgical revision after repair increasing in those with movement asymmetry. Other studies have linked asymmetries in movement following hip replacement to exacerbation of arthritic conditions, decreased functional mobility, increased fall risk, and prolonged muscle weakness. It appears that establishing baseline and early changes in movement pattern symmetry (and base comparisons to sex and age-matched persons without hip fracture) might be important for understanding/defining impairment in this population, improving interventions, and ultimately improving quality of life. Despite improvements in surgical repair in recent years, little change in outcomes and rehabilitation methods have occurred in this specific population. There is an urgent need for a novel approach to address the significant morbidity noted in older persons after hip fracture and to identify and describe what occurs in the early phases after surgical procedure. We will describe/quantify status on one of the more important tasks requiring power among older individuals/ the sit-to-stand task. This task is one of the most important predictors of continued independence vs increasing dependencies and eventual institutionalization. Movement pattern asymmetries noted in this task are likely indicative of compensated patterns in other physical tasks, and may indicate an increase in the likelihood of a future fall or further injury. We will attempt to identify movement pattern discrepancies in this population vs age/sex matched norms as well as to simply describe movement patterns with sit-to-stand task among hip fracture recipients. Additionally we look at early gait speed/gait patterns, isometric strength, and health and function survey immediately and two weeks following hip fracture, This information may well lead to improved ability to address symmetry in future rehabilitation efforts among this population in effort to improve endpoint outcomes in this group.

Principal Investigator: Robin Marcus
Department: PHYSICAL THERAPY - COH
Co Investigator: Robert Briggs
Co Investigator: Robin Marcus
Co Investigator: Micah Drummond
Co Investigator: Paul LaStayo

Contact Information

Name:Robert Briggs
Phone: 208-520-6884
Email: robert.briggs@hsc.utah.edu

Inclusion Criteria

Patient population:  We will recruit up to 60 older subjects (>55 yo) with hip fracture and/or hip replacement.  Inclusion/Exclusion criteria are outlined below.

1. Age > 55 yrs

2. Ability to sign informed consent

3. Mental status exam score > 21

4. Persons who undergo surgical repair of proximal femur/hip at University of Utah hospital following fracture.

5. Persons residing within 30 miles of University of Utah hospital facility (for 2nd assessment).

 

 

 

 

Exclusion Criteria

 

1. Bilateral hip fractures

2. Pathological fracture

3. Fracture result of multi-trauma (i.e. motor vehicle accident)

4. Unstable medical conditions such that bedside testing considered unsafe.

5. Restrictions on weight bearing status such that patient not deemed safe to bear weight as tolerated.

6. Elevated systolic pressure > 150 or a diastolic blood pressure > 100.

7. History of stroke with motor disabilty.

8. Alcohol or drug abuse.

9.Patients residing outside of 30 miles from U of Utah facility will not be measured at residence.

10.  Any other condition or event considered exclusionary by the PI or clinician.