Authors (including presenting author) :
LI SCY, CHEUNG EYY, LAU ACH, CHAN RWY, CHEUNG KWS, PANG CG, SO JKW, CHAN MTL, LEUNG KKL
Affiliation :
Physiotherapy Department, Kowloon Hospital
Keyword 1: :
hip fracture
Keyword 2: :
discharge prediction
Introduction :
With aging population, the incidence of fragility fractures in Hong Kong is increasing. Comprehensive discharge planning is essential to support patients’ return to community living and prevent secondary injuries. Early identification of rehabilitation potential enables effective care planning, goal setting, and resource utilization.
Objectives :
This study aimed to evaluate baseline differences between patients with limited and good recovery of functional independence and identify rehabilitation potential in hip fracture patients.
Methodology :
Data from patients diagnosed with hip fractures who received inpatient rehabilitation at Kowloon Hospital between 2013 and 2024 were analyzed. Assessments included pre-morbid Modified Functional Ambulation Classification(MFAC_premorbid), MFAC at admission(MFAC_admission), and Elderly Mobility Scale(EMS) at admission(EMS_admission). The EMS at discharge(EMS_discharge) was also measured. Patients were classified into two groups using EMS_discharge with cut-off of 10, distinguishing high versus minimal dependence. Between group differences were analyzed.
Result & Outcome :
A total of 2,326 patients(mean age 83.1±8.7 years) were included. At discharge, 1,438 patients scored ≤9 and 894 patients scored ≥10 on EMS. The low EMS_discharge group showed significantly lower MFAC_premorbid(5.85vs6.81), MFAC_admission(2.57vs3.64), and EMS_admission(2.70vs5.16) scores(all p< 0.001). A scoring system based on MFAC_premorbid(below 6/ 6 or above), MFAC_admission(below 3/ 3 or above), and EMS_admission(below 5/ 5 or above) was established. 1 point is given if each scoring criterion is met, indicating better functional independence. The total score is summed up(0-3) which predicted discharge independence with an area under curve of 0.802 under Receiver-Operating-Characteristic curve analysis(95% CI 0.784, 0.820, p< 0.001). Among patients scoring 0–1(n=886), only 79 of them achieved EMS_discharge ≥10, indicating high sensitivity for identifying limited rehabilitation potential. In contrast, patients scoring 2&3(n=816) demonstrated mean EMS improvements of 5.0&6.2, exceeding the minimal detectable change of 4.3, indicating strong rehabilitation gains. Using this new simple scoring system can promptly identify rehabilitation potential for hip fracture patients, enabling early tailored interventions and discharge plan recommendations, facilitating timely discharges. Moreover, earlier caregiver training can enhance safety of patients and caregivers upon discharge while the predictive tool can also guide the selection of institutional centers. These clinical tools require no extra clinical workload or assessment time for therapists and patients, securing sufficient treatment time. Resource allocation and clinical goal can be identified promptly and effectively by these simple objective outcomes.
