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Physical Activity in Young Hip Fracture Patients is Associated with Health-Related Quality of Life and Strength; Results from a Multicenter Study

  • Anna Gaki Lindestrand
    Correspondence
    Corresponding author.
    Affiliations
    Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23 2400 Copenhagen, Denmark
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  • Sebastian Strøm Rönnquist
    Affiliations
    Department of Orthopedics, Lund University, Skåne University Hospital, Carl-Bertil Laurells gata 9 21428 Malmö, Sweden

    Department of Orthopaedic Surgery and Traumatology, J.B. Winsløws Vej 4 5000 Odense University Hospital, Odense, Denmark
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  • Bjarke Viberg
    Affiliations
    Department of Orthopaedic Surgery and Traumatology, J.B. Winsløws Vej 4 5000 Odense University Hospital, Odense, Denmark

    Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24 6000 Kolding, Denmark
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  • Søren Overgaard
    Affiliations
    Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23 2400 Copenhagen, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B 2200 Copenhagen, Denmark
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  • Henrik Palm
    Affiliations
    Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23 2400 Copenhagen, Denmark
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  • Cecilia Rogmark
    Affiliations
    Department of Orthopedics, Lund University, Skåne University Hospital, Carl-Bertil Laurells gata 9 21428 Malmö, Sweden
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  • Morten Tange Kristensen
    Affiliations
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B 2200 Copenhagen, Denmark

    Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital – Amager and Hvidovre, Kettegård Allé 30 2650 Hvidovre, Denmark

    Department of Physical and Occupational Therapy, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Bispebjerg Bakke 23 2400 Copenhagen, Denmark
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Published:January 20, 2023DOI:https://doi.org/10.1016/j.injury.2023.01.037

      Highlights

      • We found that 6 out of 10 younger hip fracture patients had a PA score below WHO recommendations, this is twice as many as in the general population.
      • A PA score below WHO recommendations was associated with higher ASA, worse HRQoL and weaker hand grip strength.
      • About 90% had a DXA scan indicating osteopenia or osteoporosis, regardless of PA.

      Abstract

      Background

      The World Health Organization recommends a minimum of 150 min of moderate intensity exercise per week or 75 min of strenuous activity weekly for adults. Younger hip fracture patients are often assumed less active than the general population, however, knowledge on physical activity (PA) and health-related quality of life (HRQoL) in younger hip fracture patients is limited.

      Objectives

      We aimed to 1) investigate the variation in pre-fracture PA for adult patients with hip fractures under the age of 60; and 2) to quantify the association with patient characteristics, including outcomes of HRQOL and handgrip strength.

      Design and methods

      A prospective multicenter cohort study of 207 adult hip fracture patients under 60 years admitted to four study hospitals from July 2015 to December 2018. Data was collected through medical records, questionnaires, physical tests and interviews. PA level was assessed using a validated questionnaire from the Swedish National Board of Health and Welfare, providing a total score from 3 to 19. A score ≥11 corresponds to fulfillment of the WHO recommendation for weekly PA. Handgrip strength was measured in kilograms using a handheld dynamometer following a standardized protocol. Recall pre-fracture HRQoL was assessed using the EQ-5D-3L questionnaire.

      Results

      59% had a PA score ≤10 out of these 46% had an ASA grade of 3 or 4, 38% had a BMI over 25 and 81% had a low energy fracture. A PA score ≤10 was associated with a lower HRQoL compared to those who had a PA score ≥11. PA score ≤10 points was associated with weaker hand grip strength and a worse health status (higher ASA-grade) p<0.001.

      Conclusion

      We found that close to two-thirds of the patients had a pre-fracture PA level below WHO recommendations. Being more active was associated with better handgrip strength, HRQoL, and ASA score. Our findings indicate that individuals under 60 years who sustain a hip fracture form a heterogeneous group, some severely comorbid and others highly active and seemingly healthy. This suggests a more nuanced approach to rehabilitation, as the more active patient might need a more individualized plan than the standard program can offer.

      Keywords

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