Arbetsterapeutisk träning efter höftfraktur : aktivitetsförmåga och hälsorelaterad livskvalitet

Hip fractures constitute a common injury leading to reduced functional abilities. In a randomised trial we investigated whether an early, individualised occupational therapy training programme had any effects on patients' (> 65 years) post-operative ability to perform activities of daily life (AM), and instrumental activities of daily life (IADL), as well as self-assessments of their health-related quality of life (HRQL).

One hundred patients were assigned at random 50+50 to an intervention group (occupational therapy [OT] group) or to a control group (C-group). All patients were assessed by an occupational therapist, with the aid of the Klein-Bell ADL scale, on three occasions (3-4 days after surgery, on discharge and at follow-up 2 months after the fracture), and answered two questionnaires: a modified version of the Disability Rating Index (DRI) and the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). Each patient in the OT-group was visited at home about 6-8 days after surgery to assess the need for technical aids and/or adaptations of their home.

The assessment with the Klein-Bell ADL scale showed that on discharge the OT-group were better able to dress themselves independently (p=0.0001), to manage their personal hygiene (washing, taking a shower) (p=0.000 1) and to use the toilet and carry out toilet procedures (p=0.02). Regression analysis showed that neither age, sex, type of fracture nor duration of hospital care contributed significantly to the measured differences concerning ability to perforin ADL on discharge. Both groups improved their ADL ability over time. Two months after surgery, the ability to perform both ADL and IADL was virtually optimal for both groups, whereas self-assessed ability to move about indoors (p=0.03), to perform light housework (p=0.05) and to get into and out of a car (p=0.05) was better for the OT-group. No difference in HRQL could be demonstrated between the OT- and the C-groups, either when they were discharged from hospital or at the follow-up 2 months after the fracture.

In a follow-up 8 years after the hip fracture, including 28 patients, it was found that this group of elderly people (mean age 85 years) showed a high degree of independence. Thus, elderly patients can enjoy a functionally satisfying and independent life many years after a hip fracture.

List of scientific papers

I. Hagsten BE, Soderback (1994). Occupational therapy after hip fracture: a pilot study of the clients, the care and the costs. Clin Rehabil. 8: 142-8.

II. Hagsten B, Svensson O, Gardulf A (2004). Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fracture: a randomized trial. Acta Orthop Scand. 75(2): 177-83.
https://pubmed.ncbi.nlm.nih.gov/15180233

III. Hagsten B, Svensson O, Gardulf A (2006). Health-related quality of life and self-reported ability concerning ADL and IADL after hip fracture: a randomized trial. Acta Orthop. 77(1): 114-9.
https://pubmed.ncbi.nlm.nih.gov/16534710

IV. Hagsten B, Johansson C, Gardulf A (2006). Long-term follow-up of elderly hip fracture patients: Ability to perform activities of daily living eight years after hip fracture. [Submitted]