Studio prospettico su mobilità ed autonomia personale dopo frattura del femore prossimale

Objectives: To assess the change in ambulatory ability, need for walking aids and activities of daily life (ADL) attributable to hip fracture and to examine determinants of these functional outcomes. Design: A prospective observational cohort study. Setting: Multicenter study involving one university hospital and 2 community hospitals. Patients: A consecutive cohort of 552 patients who underwent surgery for a hip fracture. Main Outcome Measures: Ambulatory ability, need for walking aids, and ADL Index 4 and 12 months after surgery. Results: There was significant decrease in ambulatory ability and ADL Index as well as increase in the need for walking aids in comparison with the pre-fracture status at both follow-up intervals. Ambulatory ability, but not ADL significantly recovered between 4-month and one-year follow-up. One year after fracture, the pre-fracture functional status was reached by 57 % of patients and approximately 13 % of formerly ambulating patients became unable to walk. At multivariate analysis, the pre-fracture status was the most important determinant of ambulatory ability, need for walking aids, and ADL. Comorbidities, a poor cognitive status and the non-weight bearing status after surgery were also negative predictors. The fracture pattern or its specific treatment were not predictive of any functional outcomes. Conclusions: almost half of the patients fail to recover their prefracture functional level and walking ability. Recovery of ambulatory ability can occur until one year postoperatively, but ADL appear to be determined within 4 months. The pre-fracture status is the most important determinant of all functional outcomes.