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Evaluating Barriers to Achieving the Minimal Important Change in Older Patients With Hip Fractures After Post-Acute
Yueh Chen1, Fa-Chuan Kuan2,3, Chih-Kai Hong4
1Department of Orthopedics, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan.
Purpose:
Post-acute care (PAC) plays a key role in recovery following hip fractures. The aim of the study is to examine the factors affecting the achievement of the minimal important change (MIC) in older patients with hip fractures.
Methods:
This retrospective cohort study included 228 patients who underwent surgical interventions for hip fractures and received subsequent PAC between 2020 and 2021. Data on demographics, medical history, and lifestyle habits were collected. Outcomes were measured using the Barthel Index, Numeric Rating Scale (NRS), and Harris Hip Score (HHS). Univariate and multivariate regression analyses were conducted to identify predictors of achieving the MIC.
Results:
After treatment, significant improvements were observed in the Barthel Index (from 41.45 to 65.15, P < 0.001), NRS (from 5.03 to 2.52, P < 0.001), and HHS (from 29.35 to 63.68, P < 0.005). The MIC for the Barthel Index, NRS, and HHS were determined to be 6.20, 0.92, and 6.69, respectively. Dementia (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 1.51-9.44, P = 0.005), age above 80 years (OR = 2.80, 95% CI = 1.15-6.84, P = 0.024), and heart failure (OR = 4.21, 95% CI = 1.34-13.23, P = 0.014) served as significant predictors of failure to achieve the MIC with the Barthel Index. For HHS, Diabetes mellitus was the only significant predictor of failure to achieve the MIC (OR = 4.32, 95% CI = 1.00-18.62, P = 0.050).
Conclusions:
This study highlights major improvements in the Barthel Index, NRS, and HHS among older patients receiving PAC after hip fractures, along with a quantifiable MIC. Dementia is a robust predictor of failure to achieve the MIC with the Barthel Index, and advanced age, heart failure, and diabetes mellitus are key factors for optimizing recovery.
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