Abstract
Background
Lack of ability in basic mobility skills is associated with increased mortality in patients with hip fractures. The aim of this study was to identify predictors for performing basic mobility skills at discharge.
Methods
From June 2015 to May 2016, 235 consecutive patients (76% female, median age 85 (78–89 IQR)) with hip fractures admitted to the Department of Orthopedic Surgery at North Denmark Regional Hospital were included. Basic mobility was assessed at discharge using the Cumulated Ambulation Score (CAS), which consists of 1) getting in and out of bed, 2) rising from a chair and 3) walking. Possible scores for each task is: unable (CAS=0), supported (CAS=1) or independent (CAS=2). A total score of 6 indicates independence in basic mobility. Inclusion was restricted to first time hip fractures and age ≥65. Exclusion criteria were death during admission or unrecorded CAS at discharge.
Results
Before surgery 90.6% were independent in basic mobility (CAS=6). Getting out of bed at discharge: independently 37.5%, supported 56.5% and unable 6.0%. Rising from a chair: independently 49.8%, supported 43% and unable 7.2%. Walking: independently 43.8%, supported 38.3% and unable 17.9%. A total of 79 (33.6%) patients achieved independence in all tasks (CAS=6) at discharge.
Independence in: 1) getting in and out of bed, 2) rising from a chair, and 3) walking, respectively had significant association with advanced age, length of stay and Charlson Comorbidity Index >0. Medial fractures were associated with inability to rise from a chair
Advanced age was the only variable significantly associated with each task of CAS. Pre-fracture function was associated with the inability to rise from a chair and walking. Delay of surgery > 48 hours after admission was significantly associated with the inability to walk.
Conclusion
Elderly patients with comorbidities and dependent pre-fracture function should receive extra attention in rehabilitation.
