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      Physical function assessment of older adults with lower body fractures at 3 months post-discharge from hospital

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          Abstract

          Background and purpose

          Physical function assessment can be performed to assess functional mobility among older adults, especially after a traumatic incident such as lower body fracture (LBF). The objective of this study was to evaluate physical function of older patients with LBF after 3 months of discharge from the hospital.

          Patients and methods

          A total of 89 patients were followed up at the discharge phase. Four independent variables were tested: age, sex, type of fracture, and use of a walking aid before fracture. Mobility and strength were assessed with the Timed Up and Go (TUG) test and hand-grip strength (HGS) test, respectively.

          Results

          The majority of the patients were ≥65 years old (64%), female (61.8%), of Chinese ethnicity (50.6%), and had a hip fracture (51.7%). The mean time for TUG test was 26.11 seconds, while mean HGS was 19.02 kg. We found significant differences in TUG test scores with respect to all independent variables tested: age ( P=0.026), sex ( P=0.011), fracture type ( P<0.001), and use of a walking aid before fracture ( P=0.004). Significant differences were also detected in HGS test scores with respect to all independent variables tested: age ( P<0.001), sex ( P<0.001), fracture type ( P<0.001), and use of a walking aid before fracture ( P=0.035).

          Conclusion

          Increasing age, female sex, having a hip fracture, and use of a walking aid before fracture predicted reduction in the physical function and strength among older adults with LBF.

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          Most cited references 71

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          How Many Subjects Does It Take To Do A Regression Analysis.

           S Green (1991)
          Numerous rules-of-thumb have been suggested for determining the minimum number of subjects required to conduct multiple regression analyses. These rules-of-thumb are evaluated by comparing their results against those based on power analyses for tests of hypotheses of multiple and partial correlations. The results did not support the use of rules-of-thumb that simply specify some constant (e.g., 100 subjects) as the minimum number of subjects or a minimum ratio of number of subjects (N) to number of predictors (m). Some support was obtained for a rule-of-thumb that N ≥ 50 + 8 m for the multiple correlation and N ≥104 + m for the partial correlation. However, the rule-of-thumb for the multiple correlation yields values too large for N when m ≥ 7, and both rules-of-thumb assume all studies have a medium-size relationship between criterion and predictors. Accordingly, a slightly more complex rule-of thumb is introduced that estimates minimum sample size as function of effect size as well as the number of predictors. It is argued that researchers should use methods to determine sample size that incorporate effect size.
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            Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis.

            Numerous studies have reported increased risks of hip, spine, and other fractures among people who had previous clinically diagnosed fractures, or who have radiographic evidence of vertebral fractures. However, there is some variability in the magnitudes of associations among studies. We summarized the literature and performed a statistical synthesis of the risk of future fracture, given a history of prior fracture. The strongest associations were observed between prior and subsequent vertebral fractures; women with preexisting vertebral fractures (identified at baseline by vertebral morphometry) had approximately 4 times greater risk of subsequent vertebral fractures than those without prior fractures. This risk increases with the number of prior vertebral fractures. Most studies reported relative risks of approximately 2 for other combinations of prior and future fracture sites (hip, spine, wrist, or any site). The confidence profile method was used to derive a single pooled estimate from the studies that provided sufficient data for other combinations of prior and subsequent fracture sites. Studies of peri- and postmenopausal women with prior fractures had 2.0 (95 % CI = 1.8, 2.1) times the risk of subsequent fracture compared with women without prior fractures. For other studies (including men and women of all ages), the risk was increased by 2.2 (1.9, 2.6) times. We conclude that history of prior fracture at any site is an important risk factor for future fractures. Patients with a history of prior fracture, therefore, should receive further evaluation for osteoporosis and fracture risk.
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              Identifying a cut-off point for normal mobility: a comparison of the timed 'up and go' test in community-dwelling and institutionalised elderly women.

              physical mobility testing is an essential component of the geriatric assessment. The timed up and go test measures basic mobility skills including a sequence of functional manoeuvres used in everyday life. to create a practical cut-off value to indicate normal versus below normal timed up and go test performance by comparing test performance of community-dwelling and institutionalised elderly women. 413 community-dwelling and 78 institutionalised mobile elderly women (age range 65-85 years) were enrolled in a cross-sectional study. timed up and go test duration, residential and mobility status, age, height, weight and body mass index were documented. 92% of community-dwelling elderly women performed the timed up and go test in less than 12 seconds and all community-dwelling women had times below 20 seconds. In contrast only 9% of institutionalised elderly women performed the timed up and go test in less than 12 seconds, 42% were below 20 seconds, 32% had results between 20 and 30 seconds and 26% were above 30 seconds. The 10(th)-90(th) percentiles for timed up and go test performance were 6.0-11.2 seconds for community-dwelling and 12.7-50.1 seconds for institutionalised elderly women. When stratifying participants according to mobility status, the timed up and go test duration increased significantly with decreasing mobility (Kruskall-Wallis-test: p<0.0001). Linear regression modelling identified residential status (p<0.0001) and physical mobility status (p<0.0001) as significant predictors of timed up and go performance. This model predicted 54% of total variation of timed up and go test performance. residential and mobility status were identified as the strongest predictors of timed up and go test performance. We recommend the timed up and go test as a screening tool to determine whether an in-depth mobility assessment and early intervention, such as prescription of a walking aid, home visit or physiotherapy, is necessary. Community-dwelling elderly women between 65 and 85 years of age should be able to perform the timed up and go test in 12 seconds or less.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2019
                29 January 2019
                : 15
                : 201-210
                Affiliations
                [1 ]Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, anazrun@ 123456yahoo.com
                [2 ]Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
                [3 ]Department of Orthopedics & Traumatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
                Author notes
                Correspondence: Ahmad Nazrun Shuid, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Batu 9 Cheras, Kuala Lumpur, Malaysia, Tel +60 3 9145 9576, Email anazrun@ 123456yahoo.com
                Article
                tcrm-15-201
                10.2147/TCRM.S189748
                6357875
                © 2019 Ibrahim et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                lower body fracture, timed up and go test, handgrip strength test, rehabilitation

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