Key result
Clinical prediction rules incorporating age, fracture type, and care level predicted declines in activities of daily living at 6 months post-hip fracture surgery with moderate accuracy (AUC 0.825).
Why the study?
Can clinical prediction rules accurately predict declines in activities of daily living at 6 months after surgery for hip fracture repair?
Cohort (n=104)
Can clinical prediction rules accurately predict declines in activities of daily living at 6 months after surgery for hip fracture repair?
Effect estimate: AUC 0.825 (95% CI 0.728-0.923)
Clinical prediction rules using baseline and early post-operative factors can predict functional decline 6 months after hip fracture surgery with moderate accuracy.
May guide post-hip fracture care planning; leaves open prospective validation before clinical use.
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.
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Tanaka et al. (2016) conducted a cohort in hip fracture (n=104). Clinical prediction rule (CPR) models was evaluated on Declines in activities of daily living (ADL) at 6 months after surgery (AUC 0.825, 95% CI 0.728-0.923). Clinical prediction rules incorporating age, fracture type, and care level predicted declines in activities of daily living at 6 months post-hip fracture surgery with moderate accuracy (AUC 0.825).
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