Abstract
Objectives
To assess the validity of 4 functional tests in predicting falls within the first
year after hip fracture.
Design
Prospective study of functional tests shortly after hip surgery and incident falls
during 12 months' follow-up.
Setting and Participants
The sample comprised 173 adults with acute hip fracture, aged 65 years and older (79%
women, 77% community dwelling, mean age 84.2 years), who participated in a clinical
trial of vitamin D or home exercise.
Methods
We assessed 4 functional tests [Timed Up and Go test (TUG), grip strength, and knee
flexor and extensor strength in the nonoperated leg] by trained study physiotherapists
at baseline (1-12 days after hip fracture surgery). During 12 months' follow-up, we
ascertained all fall events by monthly personal phone calls, a telephone hotline,
and a patient diary. Then we compared TUG and strength test performance at baseline
between future single fallers, recurrent fallers, and nonfallers over the 12-month
follow-up. All analyses adjusted for age, body mass index, gender, 25-hydroxyvitamin
D status at baseline, days of follow-up, and treatment allocation (the original trial
tested vitamin D treatment and/or a home exercise program).
Results
Ninety-two of 173 (53%) participants fell and experienced 212 falls. Participants
who became recurrent fallers (n = 54) had significantly longer TUG times at baseline
than those who did not fall (n = 81) in the following 12 months (mean TUG for recurrent
fallers = 71.6 seconds, SD = 8.2 seconds, vs mean TUG for nonfallers = 51.4 seconds,
SD = 6.9 seconds; P = .02). There were no significant differences in TUG times between single fallers
and nonfallers. For all 3 strength tests, there were no significant differences between
single fallers, recurrent fallers, and nonfallers.
Conclusions and Implications
In this population of frail older adults recruited shortly after hip fracture surgery,
only the TUG test discriminated between future recurrent fallers and nonfallers over
a 12-month follow-up. Because of the high incidence and serious consequences of falls
in older adults after a hip fracture, it is very important to identify practical and
clinically related tests to predict repeated falls in the first year after a hip fracture,
which is of great public health importance.
Keywords
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Article info
Publication history
Published online: April 07, 2020
Footnotes
P.W. and P.O.C-B. are co–first authors.
This study was supported by Swiss National Foundations (NFP-53) (H.A.B-F. and R.T.), Vontobel Foundation (H.A.B-F.), Baugarten Foundation (H.A.B-F.), and Swiss National foundations professorship grant PP00B-114864 (H A.B-F.). The funding sources had no influence on the study design, data collection, data analyses and interpretation of results, the writing of this report, or decision to submit this manuscript for publication.
The authors declare no conflicts of interest.
Identification
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© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
