Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review

Abstract Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.

Download Full-text

The association between decreased hand grip strength and hip fracture in older people: A systematic review

Experimental Gerontology ◽

10.1016/j.exger.2018.06.022 ◽

2018 ◽

Vol 111 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Katharina Denk ◽

Sheila Lennon ◽

Susan Gordon ◽

Ruurd Lucas Jaarsma

Keyword(s):

Systematic Review ◽

Hip Fracture ◽

Older People ◽

Grip Strength ◽

Hand Grip Strength ◽

Hand Grip

Download Full-text

Sarcopenia determined by hand grip strength and calf circumference as predictor of mortality in older inpatients with hip fracture

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.104 ◽

2021 ◽

Vol 46 ◽

pp. S577

Author(s):

F.J.Sanchez Torralvo ◽

M. García Olivares ◽

V. Pérez del Río ◽

J. Abuín Fernández ◽

G. Olveira

Keyword(s):

Hip Fracture ◽

Grip Strength ◽

Hand Grip Strength ◽

Calf Circumference ◽

Hand Grip ◽

Older Inpatients

Download Full-text

A Retrospective Study of the Correlation Between Hand Grip Strength and Functional Outcomes for Clients with Shoulder Pain

World Journal of Yoga, Physical Therapy and Rehabilitation ◽

10.33552/wjypr.2020.02.000527 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Andrew Ryan Lum

Keyword(s):

Retrospective Study ◽

Grip Strength ◽

Shoulder Pain ◽

Functional Outcomes ◽

Hand Grip Strength ◽

Hand Grip

Download Full-text

The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.10683 ◽

2021 ◽

Vol 9 ◽

pp. e10683

Author(s):

Jun Chen ◽

Lingchun Lyu ◽

Jiayi Shen ◽

Chunlai Zeng ◽

Cheng Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Hip Fracture ◽

Fracture Risk ◽

Hip Fractures ◽

Observational Studies ◽

Meta Analysis ◽

Cochrane Library ◽

Hip Fracture Risk ◽

Significant Difference

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

Download Full-text

Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.10.183 ◽

2020 ◽

Vol 101 (3) ◽

pp. 553-565 ◽

Cited By ~ 10

Author(s):

Pavlos Bobos ◽

Goris Nazari ◽

Ze Lu ◽

Joy C. MacDermid

Keyword(s):

Systematic Review ◽

Grip Strength ◽

Meta Analysis ◽

Hand Grip Strength ◽

Measurement Properties ◽

Strength Assessment ◽

Hand Grip

Download Full-text

Validity of hand grip strength, anthropometry and bioimpedanciometry as determinants of reduced muscle mass in application of glim criteria in older inpatients with hip fracture

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.149 ◽

2021 ◽

Vol 46 ◽

pp. S594

Author(s):

F.J. Sanchez Torralvo ◽

M. Garcia Olivares ◽

J. Abuín Fernández ◽

V. Pérez del Río ◽

G. Olveira

Keyword(s):

Hip Fracture ◽

Grip Strength ◽

Muscle Mass ◽

Hand Grip Strength ◽

Hand Grip ◽

Older Inpatients

Download Full-text

Hand grip strength and its correlation with vitamin D in Indian patients with hip fracture

Archives of Osteoporosis ◽

10.1007/s11657-013-0158-8 ◽

2013 ◽

Vol 8 (1-2) ◽

Cited By ~ 8

Author(s):

Dinesh K. Dhanwal ◽

Pramila Dharmshaktu ◽

V. K. Gautam ◽

N. Gupta ◽

Alpana Saxena

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Grip Strength ◽

Hand Grip Strength ◽

Hand Grip ◽

Indian Patients

Download Full-text

Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

PLoS ONE ◽

10.1371/journal.pone.0213223 ◽

2019 ◽

Vol 14 (8) ◽

pp. e0213223 ◽

Cited By ~ 8

Author(s):

Ivan Selakovic ◽

Emilija Dubljanin-Raspopovic ◽

Ljiljana Markovic-Denic ◽

Vuk Marusic ◽

Andja Cirkovic ◽

...

Keyword(s):

Hip Fracture ◽

Functional Outcome ◽

Grip Strength ◽

Hand Grip Strength ◽

Early Assessment ◽

Hand Grip

Download Full-text

Factors Associated with Sarcopenia and 7-Year Mortality in Very Old Patients with Hip Fracture Admitted to Rehabilitation Units: A Pragmatic Study

Nutrients ◽

10.3390/nu11092243 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2243 ◽

Cited By ~ 1

Author(s):

Vincenzo Malafarina ◽

Concetta Malafarina ◽

Arantzazu Biain Ugarte ◽

J. Alfredo Martinez ◽

Itziar Abete Goñi ◽

...

Keyword(s):

Hip Fracture ◽

Older People ◽

Hospital Stay ◽

Grip Strength ◽

Older Patients ◽

Hand Grip Strength ◽

Factors Associated ◽

Hand Grip ◽

Risk Of Mortality

Background: Admitted bedridden older patients are at risk of the development of sarcopenia during hospital stay (incident sarcopenia). The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Methods: A multicenter, pragmatic, prospective observational study was designed. Older subjects with hip fracture admitted to two rehabilitation units were included. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. The mortality was evaluated after 7 years of follow-up. Results: A total of 187 subjects (73.8% women) age 85.2 ± 6.3 years were included. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index. During follow-up 114 patients died (60.5% sarcopenic vs. 39.5% non-sarcopenic, p = 0.001). Cox regression analyses showed that factors associated to increased risk of mortality were sarcopenia (HR: 1.67, 95% CI 1.11–2.51) and low hand-grip strength (HR: 1.76, 95% CI 1.08–2.88). Conclusions: Older patients with undernutrition have a higher risk of developing sarcopenia during hospital stay, and sarcopenic patients have almost two times more risk of mortality than non-sarcopenic patients during follow-up after hip fracture.

Download Full-text