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Identifying Key Balance Skills Predicting Functional Independence After Hip Fracture: A Decision Tree Analysis of
Hiroaki Yoshida1,2, Yasuhide Nakayama3, Kenji Higuchi1
1Department of Rehabilitation Medicine, The Jikei University School of Medicine Kashiwa Hospital, Japan.
Aim:
Hip fractures in older adults often result in decreased mobility and independence. This study aimed to identify critical balance skills that distinguish different activity levels following fracture, using sub-items of the Berg Balance Scale (BBS).
Methods:
This retrospective cross-sectional study analyzed the medical records of 252 older adults (mean age 79.8 ± 8.8 years) with hip fractures. Participants were classified into Independent (n = 90), House-bound (n = 92), and Chair-bound (n = 70) groups based on the Japanese Bedriddenness Rank (BR). Decision tree analysis was performed using BBS sub-items as predictors of activity level.
Results:
Key discriminators between activity levels were identified: "360° Turning" and "Sit to Stand" differentiated the Independent from the House-bound groups, while "Reaching Forward While Standing" and "Standing Unsupported" distinguished the House-bound from Chair-bound groups. Model accuracy was 81.9% (AUC 0.894) for Independent vs House-bound and 83.3% (AUC 0.910) for House-bound vs Chair-bound groups.
Discussion:
Our results offer a novel, evidence-based approach to tailoring rehabilitation strategies for hip fracture patients. By focusing on these critical balance skills, patient functional outcomes may improve, ultimately enhancing quality of life in older adults following hip fracture.
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