Background
-
Hypothesis 1 (H1): HRQoL, including physical and mental health-related health outcomes, during the first year after hospital discharge following hip fracture has multiple distinct trajectories that can be characterized as poor, moderate, and good [5].
-
Hypothesis 2 (H2): Receiving the comprehensive and interdisciplinary care models increases patients’ odds of being in a good physical and good mental health trajectories over time compared with the usual care model.
Methods
Design and setting
Subjects
Usual care
Interdisciplinary care model
Geriatric consultation
Rehabilitation program
Discharge planning
Comprehensive care model
Rehabilitation program
Fall prevention
Nutritional consultation/education
Depression screening and management
Measurements
HRQoL
Pre-fracture performance of ADLs
Ethical considerations
Procedures
Data analysis
Results
Subject characteristics
Characteristic | Mean (SD) |
n (%) |
---|---|---|
Age, years | 76.36 (7.28) | |
Gender | ||
Female | 181 (64.4) | |
Marital status | ||
Married | 148 (52.7) | |
Widowed/divorced | 133 (47.3) | |
Educational background | ||
Illiterate | 124 (44.1) | |
≥ Primary school | 157 (55.9) | |
Number of comorbidities a
| 2.39 (1.48) | |
Type of fracture | ||
Femoral neck | 161 (57.3) | |
Trochanteric | 120 (42.7) | |
Type of surgery | ||
Arthroplasty | 104 (37.0) | |
Internal fixation | 177 (63.0) | |
Pre-fracture independence in ADL | ||
Yes | 190 (67.6) | |
No | 91 (32.4) | |
PCS score | ||
Baseline (1 month post discharge) | 45.53 (5.92) | |
3 months | 53.14 (9.40) | |
6 months | 59.27 (10.42) | |
12 months | 63.67 (10.88) | |
MCS score | ||
Baseline (1 month post discharge) | 55.31 (9.72) | |
3 months | 55.54 (8.51) | |
6 months | 53.54 (8.93) | |
12 months | 51.97 (9.53) | |
Attrition | ||
Baseline (1 month post discharge) | 7 (2.49) | |
3 months | 20 (7.11) | |
6 months | 33 (11.74) | |
12 months | 46 (16.37) |
Trajectories of PCS and MCS
PCS
Growth parameter | PCS classes | MCS classes | ||||
---|---|---|---|---|---|---|
Poor | Moderate | Good | Poor | Moderate | Good | |
Intercept | 3.72***
| 3.71***
| 3.83***
| 3.75***
| 3.95***
| 4.11***
|
Linear slope | 0.04***
| 0.08***
| 0.11***
| -0.010 *
| -0.007**
| -0.005***
|
Quadratic slope | -0.002**
| -0.004***
| -0.006***
| |||
Group proportion | 36.65 | 34.16 | 29.18 | 13.87 | 29.89 | 56.23 |
Alpha0 | -21.28 | -21.14 | ||||
Alpha1 | 0.26 | -0.23 | ||||
Alpha2 | -0.05 | |||||
Model fit statistics | ||||||
BIC (N =1018) | -3545.68 | -3578.91 | ||||
BIC (N =281) | -3536.67 | -3572.48 | ||||
AIC fit index | -3511.21 | -3554.29 | ||||
Log likelihood | -3497.21 | -3544.29 |
MCS
Intervention effects on distinct trajectories of PCS and MCS
Trajectory | Parameter | βa
| SEa
| Odds ratio (95%CI) |
---|---|---|---|---|
Poor PCS | Reference group | |||
Moderate PCS | Constant | -0.04 | 0.43 | 0.96 (2.23–0.42) |
Comprehensive group | 0.34 | 0.47 | 1.40 (3.54–0.56) | |
Interdisciplinary group | 0.73 | 0.49 | 2.08 (5.46–0.80) | |
Attrition | -1.27 | 1.24 | 0.28 (3.18–0.02) | |
Pre-fracture ADL dependent | -0.49 | 0.43 | 0.61 (1.42–0.26) | |
Good PCS | Constant | -0.63 | 0.49 | 0.53 (1.39–0.20) |
Comprehensive group | 0.99 | 0.50 | 2.69 (7.24–1.00) *
| |
Interdisciplinary group | 1.32 | 0.53 | 3.75 (10.53–1.33) *
| |
Attrition | -0.94 | 0.68 | 0.39 (1.49–0.10) | |
Pre-fracture ADL dependent | -2.27 | 0.96 | 0.10 (0.68–0.02) *
| |
Model fit statistics | ||||
BIC (N = 1018) | -3558.53 | |||
BIC (N = 281) | -3544.37 | |||
AIC fit index | -3504.35 | |||
Log likelihood | -3482.35 |
Trajectory | Parameter | βa
| SEa
| Odds ratio (95%CI) |
---|---|---|---|---|
Poor MCS | Reference group | |||
Moderate MCS | Constant | 0.94 | 0.71 | 2.55 (10.37–0.63) |
Comprehensive group | 0.32 | 0.66 | 1.38 (5.10–0.38) | |
Interdisciplinary group | 1.24 | 0.72 | 3.46 (14.37–0.83) | |
Attrition | -1.83 | 1.36 | 0.16 (2.32–0.01) | |
Pre-fracture ADL dependent | -1.14 | 0.67 | 0.32 (1.19–0.09) | |
Good MCS | Constant | 1.74 | 0.66 | 5.70 (20.77–1.57)**
|
Comprehensive group | 0.25 | 0.48 | 1.28 (3.28–0.50) | |
Interdisciplinary group | 0.86 | 0.61 | 2.37 (7.88–0.71) | |
Attrition | -1.10 | 0.55 | 0.33 (0.97–0.11)*
| |
Pre-fracture ADL dependent | -1.17 | 0.49 | 0.31 (0.81–0.12)*
| |
Model fit statistics | ||||
BIC (N = 1018) | -3598.60 | |||
BIC (N = 281) | -3587.02 | |||
AIC fit index | -3554.27 | |||
Log likelihood | -3536.27 |