PURPOSE: Patients who sustain fall-related distal forearm fractures are at risk to sustain new fractures later in life. Risk factors for falls such as low physical activity, impaired gait and neuromuscular function, and comorbidity are well known, as well as risk factors for fractures such as female gender, old age, low body mass index (BMI) and low mobility. Fracture prevention is often directed toward bone mass density treatment, but there is evidence that high level of physical activity reduces falls and therefore also reduces fractures. Health related quality of life (HRQoL) has become an important additional measure. The aims of this study were to evaluate the HRQoL, reported with EQ-5D and SF-12, in women who had sustained fall-related distal forearm fracture one year earlier and compare with Swedish normative data, and to physical performance and self-reported comorbidity.

PARTICIPANTS: Sixty women with a fall-related distal forearm fracture were invited to examine health-related quality of life and physical performance at a mean time of 13 months after they had sustained their fracture (S.D. 1.6, range 10–17). The inclusion criteria were that they should be able to perform the physical tests and to understand verbal and written Swedish. Forty three women (72%), mean age 68 (SD 8.4, range 50–84), agreed to participate.

METHODS: The women filled in two generic HRQoL-questionnaires; EQ-5D and SF-12. They self-rated their physical activity and reported ailments, which were regularly examined by a doctor, and intake of prescribed medication. They reported problems or difficulties from the locomotor system and depressive symptoms during the three last months. All women underwent physical performance tests; handgrip strength, one leg standing (OLS) and walking speed. Fisher’s exact test, Mann Whitney U test and Spearman’s rank correlation coefficient were used in the statistical analyses.

RESULTS: In the younger women (age 50–59) the HRQoL was lower compared to Swedish normative data. The EQ-5D index and VAS scores correlated moderately to the physical component summary (PCS-12) of the SF-12 (rs=0.73 and rs=0.69, respectively). The correlation to the mental component summary (MCS-12) of the SF-12 was lower (rs=0.32 and rs=0.22, respectively). Women who reported comorbidity and low physical activity scored lower in the corresponding items of health in both questionnaires.

CONCLUSIONS: Low results in HRQoL questionnaires in apparently healthy older women with fall-related distal forearm fracture may indicate underlying comorbidity, not captured by physical performance tests. We suggest that HRQoL questionnaires should be used in additional to physical outcome measures for this patient group. The use of HRQoL questionnaires to find patients for preventive measures of falls and fractures should be further explored.

Objectives:

To gain an understanding of the current issues surrounding falls prevention across Europe and to embrace at national and international level, the different political and health service agendas in each country such that recommendations can ultimately be translated into working models of practice in each country.

Description of work: This work package focuses on the development of a consensus approach to the assessment and management of falls in older people across Europe. Fundamental to this process is the development of a clear understanding of how services across Europe are currently configured and what the national and international drivers for change might be over the next 5–10yrs. The ultimate aim is to be able to facilitate the development of a set of comparable assessment and outcome measures to be used in a large randomised controlled trial with fracture as the primary outcome measure. Year 1. Whilst undertaking the networking exercise in year 1, members had the opportunity to visit key individuals in European countries and anticipate the potential opportunities and constraints of developing and delivering falls services in a co-ordinated and comprehensive fashion. Year 2 focuses on the development of assessment tools, which can be tailored so as to be applied in a variety of clinical settings from community based assessment to the highly specialised investigation units. The work package links closely with other work packages on balance and gait and psychology to ensure consensus in recommendations. In addition to the recommendations for clinical assessment and management, the work package also provides advice and guidance on evaluation and audit of services and as such links closely with the taxonomy work. Recommendations are to be peer reviewed. Year 3 entails the collation of agreed assessment and evaluation methods and the translation of the recommendations into a format for dissemination including written documentation translated into a number of different languages and an interactive website with links to relevant organisation across Europe and the rest of the world. Year 4. During the final year, members of the work package take responsibility for the dissemination of the work to clinical colleagues.