title: Factors Predicting Mobility and the Change in Activities of Daily Living After Hip Fracture: A 1-Year Prospective Cohort Study.
abstract: OBJECTIVE
  To assess the change in ambulatory ability, need for walking aids, and activities of daily living (ADL) after femoral neck, intertrochanteric, or subtrochanteric fractures and to examine the determinants of these functional outcomes.
  
  
  METHODS
  A prospective observational cohort study.
  
  
  METHODS
  A multicenter study involving 1 university hospital and 2 community hospitals.
  
  
  METHODS
  A consecutive cohort of 552 patients (mean age, 78.3 years; range, 50-105) who underwent surgery for a hip fracture.
  
  
  METHODS
  Ambulatory ability, need for walking aids, and ADL index, 4 and 12 months after surgery.
  
  
  RESULTS
  At both 4 months and 1-year follow-up time points, there was a significant decrease in ambulatory ability and the ADL index score and also an increase in the need for walking aids in comparison with the prefracture status. Ambulatory ability, but not ADL, significantly recovered between the 4-month and 1-year follow-up. One year after fracture, the prefracture functional status was regained by 57% of the patients, but approximately 13% of the formerly ambulating patients were unable to walk. The prefracture status was the most important determinant of ambulatory ability, need for walking aids, and ADL. Comorbidities, a poor cognitive status, and non-weight-bearing status after surgery were also negative predictors. Neither the fracture pattern nor its specific surgical treatment was predictive of any functional outcomes.
  
  
  CONCLUSIONS
  Regardless of the type of fracture or surgical treatment used, 57% of the patients do not regain their prefracture ambulatory ability. Recovery of ambulatory ability can occur until 1 year postoperatively. The prefracture status and cognitive level are the most important determinant of all functional outcomes.
  
  
  METHODS
  Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy; †Department of Orthopaedic Surgery, "Umberto I" Hospital, Nocera Inferiore, Italy; and ‡Unit of Hip Surgery, "A. Cardarelli" Hospital, Naples, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mariconda
authors.forename: Giovan Giuseppe
authors.initials: GG
authors.lastname: Costa
authors.forename: Simone
authors.initials: S
authors.lastname: Cerbasi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Recano
authors.forename: Gianclaudio
authors.initials: G
authors.lastname: Orabona
authors.forename: Monica
authors.initials: M
authors.lastname: Gambacorta
authors.forename: Mario
authors.initials: M
authors.lastname: Misasi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology*; D006620:Hip Fractures / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome