Quality of life after hip fracture: a comparison of four health status measures in 208 patients.
OBJECTIVE
We compared four health status measures for the evaluation of quality of life after hip fracture.


METHODS
Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated.


RESULTS
At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning.


CONCLUSIONS
To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.
Nursing and Rehabilitation Centre Antonius Binnenweg, Nieuwe Binnenweg 33 3014 GC, Rotterdam, The Netherlands. R.vanBalen@kvv.nl
Romke
R
Van Balen
Marie Louise
ML
Essink-Bot
Ewout
E
Steyerberg
Herman
H
Cools
Dik F
DF
Habbema
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006305:Health Status Indicators; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011788:Quality of Life; D020127:Recovery of Function; D015203:Reproducibility of Results; D012647:Self-Assessment; D011795:Surveys and Questionnaires