Authors (including presenting author) :
Lee JWY, Yeung MTH, Chan CTM, Chan SWI, Cheng RYF, Chu AL, Chao CYL, Leung CYY
Affiliation :
Physiotherapy Department, Princess Margaret Hospital
Introduction :
Fragility hip fracture (FHF) presents a significant health concern among the elderly, often leading to decreased mobility and increased morbidity. Handgrip strength (HGS) serves as an effective measure of overall muscle strength and is a reliable indicator of sarcopenia in older adults. Research indicates that lower HGS is associated with poorer rehabilitation outcomes and increased disability following hip fractures. Though stand-alone measures of handgrip strength provide robust health outcomes, little is known about its association with the mobility level. Elderly Mobility Scale (EMS) is a validated tool for assessing mobility in older adults with higher score indicates better mobility and independences in a 0 to 20 points scale, aiding in identifying individual at risk of falling.
Objectives :
To investigate the rehabilitation outcomes and the correlation between HGS, mobility level and length of stay (LOS) in older people after fragility hip fractures in acute ward settings.
Methodology :
A retrospective study was conducted. Older people aged 60 years or above suffered acute FHF and admitted to the Princess Margaret Hospital (PMH) that required surgical intervention and referred for physiotherapy management in the period of July to December 2024 were evaluated. Patients with unstable medical condition or inability to participate in physical assessments were excluded for analysis. Demographic variables, LOS, discharge destination, and outcomes on Modified Functional Ambulatory Category (MFAC), HGS, EMS were retrieved for analysis. The correlation between HGS versus EMS score and LOS was analyzed using Spearman’s rank correlation coefficient statistical analysis.
Result & Outcome :
One hundred and five patients (38 males, 67 females), with a mean age of 82.6 ± 9.3 years were evaluated. Majority of them (86, 81.9%) were indoor or outdoor walkers at premorbid status. The mean HGS at admission status was 13.3±7.7 kgf and the mean discharge score of EMS was 3.9±0.13. The averaged LOS was 15.9±10 days. At discharge status, 34 (32.4%) of patients were sitter, 59 (56.2%) were dependent or assisted walker, 4 (3.8%) were supervised walker and only 1 (1%) was indoor walker. For discharge destination, 77 (73.4%) of the patients were transferred to rehabilitation hospital, followed by 19 (18.1%) direct discharged home and 9 (8.6%) others. A moderate positive correlation was observed between admission HGS and discharge EMS score level (p=<0.001, r=0.543) while a weak negative correlation was observed between admission HGS vs. LOS (p=0.023, r=-0.222). Older people are generally medically frail in the acute phrase after hip fracture. HGS is easy to be measured and clinically less time consuming and commonly be used to reflect the overall muscle strength capacity. Our preliminary findings demonstrated that admission HGS was positively associated with the discharge EMS score of older people after acute FHF, suggesting that a reduction in HGS may signify not only muscle weakness but also impairment of the overall functional mobility level. There was only a weak association between HGS and LOS observed. Further longitudinal studies should be conducted to develop a predictive model of HGS for facilitating the prioritization of patients for transferring to rehabilitation hospital for better resources allocation and promote rehabilitation outcomes.
