title: Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months After Surgery for Hip Fracture Repair.
abstract: To develop and assess a clinical prediction rule (CPR) to predict declines in activities of daily living (ADL) at 6 months after surgery for hip fracture repair.
  
  
  
  Prospective, cohort study.
  
  
  
  From hospital to home.
  
  
  
  Patients (N=104) with hip fractures after surgery.
  
  
  
  Not applicable.
  
  
  
  ADL were assessed using the Barthel Index at 6 months after surgery.
  
  
  
  At 6 months after surgery, 86 patients (82.6%) were known to be alive, 1 patient (1.0%) had died, and 17 (16.3%) were lost to follow-up. Thirty-two patients (37.2%) did not recover their ADL at 6 months after surgery to levels before fracture. The classification and regression trees methodology was used to develop 2 models to predict a decline in ADL: (1) model 1 included age, type of fracture, and care level before fracture (sensitivity=75.0%, specificity=81.5%, positive predictive value=70.6%, positive likelihood ratio=4.050); and (2) model 2 included the degree of independence 2 weeks postsurgery for ADL chair transfer, ADL ambulation, and age (sensitivity=65.6%, specificity=87.0%, positive predictive value=75.0%, positive likelihood ratio=5.063). The areas under the receiver operating characteristic curves of both CPR models were .825 (95% confidential interval, .728-.923) and .790 (95% confidence interval, .683-.897), respectively.
  
  
  
  CPRs with moderate accuracy were developed to predict declines in ADL at 6 months after surgery for hip fracture repair.
authors.affiliation: Department of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan. Electronic address: r-tanaka@hs.hirokoku-u.ac.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Rehabilitation, Saiseikaikure Hospital, Kure, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Umehara
authors.affiliation: Department of Rehabilitation, Chūgokurōsai Hospital, Kure, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Fujimura
authors.affiliation: Department of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Ozawa
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D006620:Hip Fractures / Q000145:classification / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012111:Residence Characteristics; D012737:Sex Factors; D013997:Time Factors
keywords: Activities of daily living; Hip fractures; Prognosis; Rehabilitation