Development of a Clinical Prediction Rule to Determine Walking Independence in Older Adults With Hip Fractures

Taiki Iwamura; Hiroki Iwamoto; Shota Saito; Yoichi Kaizu; Shuntaro Tamura; Ren Takeda; Sota Kobayashi; Kazuhiro Miyata

doi:10.7759/cureus.72329

Development of a Clinical Prediction Rule to Determine Walking Independence in Older Adults With Hip Fractures

Cureus. 2024 Oct 24;16(10):e72329. doi: 10.7759/cureus.72329. eCollection 2024 Oct.

Authors

Taiki Iwamura¹, Hiroki Iwamoto², Shota Saito³, Yoichi Kaizu², Shuntaro Tamura⁴, Ren Takeda⁵, Sota Kobayashi⁶, Kazuhiro Miyata⁷

Affiliations

¹ Department of Rehabilitation, Azumabashi Orthopedics, Tokyo, JPN.
² Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaki, JPN.
³ Department of Rehabilitation, Fujioka General Hospital, Fujioka, JPN.
⁴ Department of Physical Therapy, Ota College of Medical Technology, Ota, JPN.
⁵ Department of Rehabilitation, Day Care Center Specialized in Stroke Rehabilitation "With Reha", Gunma, JPN.
⁶ Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, JPN.
⁷ Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, JPN.

Abstract

Introduction and aim: Accurate determination of walking independence in older adults after hip fracture surgery is crucial for selecting appropriate walking strategies and providing fall prevention guidance. We developed and validated a clinical prediction rule (CPR) to determine level-surface walking independence and community walking independence in older adults with hip fractures.

Methods: In a multicenter, cross-sectional study, we investigated 289 older inpatients with hip fractures. A backward stepwise logistic regression analysis was performed to develop a CPR for determining level-surface walking independence and community walking independence. The independent variables incorporated the patients' walking and balance evaluations at discharge, including the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and maximum walking speed (MWS), as well as age and cognitive function evaluations. We used a bootstrap internal validation for the CPR's internal validation.

Results: At their hospital discharge, 171 patients had achieved level-surface walking independence, and 51 had achieved community walking independence. As the level of walking independence decreased, patients tended to be older, with lower BBS scores and slower TUG times and walking speeds. As diagnostic factors, the level-surface walking model included age, BBS, and cognitive decline; the community walking model included BBS, TUG, and MWS. The diagnostic accuracy, represented by the area under the curve (confidence interval), was 0.88 (0.84-0.92) for the level-surface walking model and 0.81 (0.74-0.87) for the community walking model. Internal validation confirmed that the models' discrimination accuracy was good, and no model overfitting was observed.

Conclusions: We developed a moderately accurate CPR to determine walking independence in hip fracture patients. CPR can be a useful indicator for determining an individual's walking independence at present, but external validations with other samples are necessary.

Keywords: clinical decision; fall prevention; mobility; rehabilitation medicine; walking ability.

Grants and funding

This study is supported by a Grant-in-Aid for Encouragement of Young Scientists from Ibaraki Prefectural University of Health Sciences.