Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months After Surgery for Hip Fracture Repair

Abstract

Objectives: To develop and assess a clinical prediction rule (CPR) to predict declines in activities of daily living (ADL) at 6 months after surgery for hip fracture repair.

Design: Prospective, cohort study.

Setting: From hospital to home.

Participants: Patients (N=104) with hip fractures after surgery.

Interventions: Not applicable.

Main outcome measure: ADL were assessed using the Barthel Index at 6 months after surgery.

Results: At 6 months after surgery, 86 patients (82.6%) were known to be alive, 1 patient (1.0%) had died, and 17 (16.3%) were lost to follow-up. Thirty-two patients (37.2%) did not recover their ADL at 6 months after surgery to levels before fracture. The classification and regression trees methodology was used to develop 2 models to predict a decline in ADL: (1) model 1 included age, type of fracture, and care level before fracture (sensitivity=75.0%, specificity=81.5%, positive predictive value=70.6%, positive likelihood ratio=4.050); and (2) model 2 included the degree of independence 2 weeks postsurgery for ADL chair transfer, ADL ambulation, and age (sensitivity=65.6%, specificity=87.0%, positive predictive value=75.0%, positive likelihood ratio=5.063). The areas under the receiver operating characteristic curves of both CPR models were .825 (95% confidential interval, .728-.923) and .790 (95% confidence interval, .683-.897), respectively.

Conclusions: CPRs with moderate accuracy were developed to predict declines in ADL at 6 months after surgery for hip fracture repair.

Keywords: Activities of daily living; Hip fractures; Prognosis; Rehabilitation.