Comparative Effectiveness of Functional Tests in Fall Prediction After Hip Fracture

Rehabilitation Prognostic Factors following Hip Fractures Associated with Patient's Pre-Fracture Mobility and Functional Ability: A Prospective Observation Study

Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool.

Wearable Sensor-Based Prediction Model of Timed up and Go Test in Older Adults

The Timed Up and Go (TUG) test has been frequently used to assess the risk of falls in older adults because it is an easy, fast, and simple method of examining functional mobility and balance without special equipment. The purpose of this study is to develop a model that predicts the TUG test using three-dimensional acceleration data collected from wearable sensors during normal walking. We recruited 37 older adults for an outdoor walking task, and seven inertial measurement unit (IMU)-based sensors were attached to each participant. The elastic net and ridge regression methods were used to reduce gait feature sets and build a predictive model. The proposed predictive model reliably estimated the participants' TUG scores with a small margin of prediction errors. Although the prediction accuracies with two foot-sensors were slightly better than those of other configurations (e.g., MAPE: foot (0.865 s) > foot and pelvis (0.918 s) > pelvis (0.921 s)), we recommend the use of a single IMU sensor at the pelvis since it would provide wearing comfort while avoiding the disturbance of daily activities. The proposed predictive model can enable clinicians to assess older adults' fall risks remotely through the evaluation of the TUG score during their daily walking.

The effectiveness of a recurrent fall prevention program applied to elderly people undergoing fracture treatment

BACKGROUND

Worldwide 30-40% of people aged of 65 and over fall each year. It is important to develop preventive interventions for falls in the elderly to prevent injuries leading to mortality and morbidity.

OBJECTIVES

This study evaluated the effectiveness of a recurrent fall prevention program in elderly individuals undergoing fracture treatment.

METHODS

A pretest-posttest intervention study. A recurrent fall prevention program including assessment of fall risk factors, education on falls and home modifications was developed for elderly people undergoing fracture treatment for 52 patients.

RESULTS

In the first evaluation before the delivery of the recurrent fall prevention program, the number of risk factors was 17.63 ± 3.40 as mean ± standart deviation. Following implementation of the fall prevention program, the number of risk factors decreased to 15.73 ± 3.19 in the first follow-up and decreased to 14.92 ± 3.06 in the second follow-up. Knowledge scores increased to 6.09 ± 1.65 in the first follow-up and to 6.71 ± 1.53 in the second follow-up, while it was 5.50 ± 1.54 in first evaluation. The differences between follow-ups were statistically significant. During the 3-month study period, 15.4% of participants experienced fall.

CONCLUSION

The recurrent fall prevention program was effective in reducing fall-related risk factors and increase fall knowledge. Health care professionals should assess older people for fall risk factors and increase their awareness for falls.