Authors (including presenting author) :
Yeung JYH(1), KWOK ML(1), NG YM(1), NG OY(1)(2), FUNG YH(1)
Affiliation :
(1)Physiotherapy Department, Caritas Medical Centre, (2)Kowloon West Cluster Family Medicine and Primary Health Care Department
Introduction :
One of the major risk factors for future fragility fracture is a prior fragility fracture.[1] Secondary prevention of osteoporosis and falls provide optimal recovery after fragility hip fracture and help to prevent subsequent fractures.[2] After successful in-patient rehabilitation, follow up assessment and interventions are provided by the multidisciplinary team at CMC Fragility Fracture Clinic. In conjunction with medical treatment, and non-pharmacological treatments such as physiotherapy play a significant role to play in the secondary prevention of falls and fractures through exercise for to improving patient’s balance, strength and bone health.[3]
Objectives :
• Descriptive and evaluation of outcomes on functional mobility, balance performance and balance confidence in patients with fragility hip fracture at approximately four to six months post fracture. • Analysis of data for physiotherapy service improvement and provision in hip fragility fracture rehabilitation.
Methodology :
Retrospective observational review using physiotherapy outcome measures documented during the period from July 2011 to July 2016, for patients who attended multi-disciplinary fragility fracture clinic at 4-6 months post injury for secondary fracture prevention. Functional mobility was assessed using Elderly Mobility Scale (EMS) and Modified Functional Ambulatory Classification (MFAC). Balance performance was assessed using the Berg Balance Scale (BBS), and balance confidence was assessed using validated Chinese version of Activities-specific Balance Confidence Scale (ABC-C) survey.[4] Patients were further stratified based on their mobility level and grouped as: Independent outdoor walker (MFAC 7), Independent indoor walker (MFAC 6) or Assisted walker (MFAC 3-5). The SPSS software ver. 22 (SPSS Inc., Chicago, IL, USA) was used for data analysis. Means of outcome measures between groups were compared using One-Way ANOVA. Pearson correlation analysis was used to investigate the correlation between outcome measures. Results: A total of 228 patient data (female =168, male=60) with mean age 80.3 ± 8.04 were analyzed. There were 63 assisted walkers, 55 independent indoor walkers, and 110 independent outdoor walkers. Correlation analysis found a strong association between ABC Scale and BBS scores (r = .83, p < 0.001)., between ABC Scale and EMS scores (r = .81, p < .001)., and between BBS and EMS scores (r = .90, p < .001). When analyzed by stratified group, mean test scores ± (SD) for variables of interest were; Assisted walkers: BBS = 21.94 ± 9.45, ABC Scale = 14.27 ± 9.56, EMS 9.35 ± 2.81, Independent Indoor walkers: BBS = 35.75 ± 4.76, ABC Scale = 34.92 ± 12.05, EMS 14.02 ± 2.11, Independent Outdoor walkers: BBS = 44.75 ± 5.94, ABC Scale = 59.84 ± 18.83, EMS 17.22 ± 1.56. One-way ANOVA analysis found significant effect (p< .001) between groups of different mobility level. Post Hoc comparison using Turkey HSD test indicated that the mean scores for BBS, ABC-C, and EMS were all statistically significant (p < .001) using pairwise comparison between assisted walkers, independent indoor walkers, and independent outdoor walkers.
Result & Outcome :
Discussion: The results were in line with previous studies on community-dwelling elderly which demonstrated that balance confidence, balance performance and functional mobility were strongly associated.[4] Balance performance (BBS) of outdoor independent walkers in this study was near cut off score 45/56, which was similar to community-dwelling elderly.[5] Despite being ambulatory independent at outdoor level, balance confidence (ABC-C) was below the cut-off score of 67% which was used to classify as community-dwelling elderly as fallers and non-fallers.[6] The impact of decreased balance confidence and fear of falling is far-reaching. It has been observed that fear anxiety and enhances a stiffening strategy during control of posture and affects the ability to respond effectively to a sudden, unexpected balance perturbation. In addition, lack of balance confidence leads to activity restriction, diminished mobility, and increased the likelihood of suffering another fragility fracture. In a prospective cohort on elderly, psychological measures on fear of falls such as ABC were more predictive of fall risk than physical measures (BBS and Time-UP and go test), history of falls, or presence of pathology. [7] While the design of retrospective review has its limitations, result implicate for enhancement of interventions to address balance confidence and fear of falling. Physiotherapist can educate patients on a realistic assessment of their self-concept of falls and risk for falls, which is complemented by task orientated practice and strategies to increase their perceived control over the environment. Assertive training helps build confidence when patients repeatedly complete a feared task consecutively and help them to move from self-defeating thoughts to motivating thoughts on controlling this fear. Improvement in both physical functions and balance confidence facilitate improvements in rehabilitation outcomes, enhance integration of patients back to community activities, and avoid detrimental effects of inactivity and its related risk for falls.
Co-location with:
