51 A Prospective Study on Falls Efficacy and Functional Outcomes after HIP Fracture Surgery in a Singapore Orthogeriatric Programme

Abstract

Introduction: Fear of Falling (FoF) is common after hip fracture and associated with adverse outcomes including impaired functional recovery and recurrent falls. The objective of this study was to measure self-efficacy related to falls and its association with functional outcomes after hip fracture surgery. Methods: A prospective cohort study was performed on 106 community-dwelling elderly aged ≥65 years without dementia, admitted to a community hospital for rehabilitation after surgery for fragility hip fracture in Singapore. They were managed in an integrated multidisciplinary orthogeriatric programme, transitioning from acute orthopaedic unit to the affiliated community hospital. Falls Efficacy Scale (FES; range 10-100) was assessed on discharge. Main outcomes measured included Parker Mobility Score (PMS) and Modified Barthel Index (MBI) at 3 months. Results: Key characteristics of the cohort were: mean age 79.4(SD 6.38); female 74%, Chinese 83%, pre-fracture PMS 6.7(SD 2.7); pre-fracture MBI 81.1(SD 20.9); mean FES score 32.0(SD 23.7). At 3 months, mean PMS was 3.97(SD 2.51); mean MBI was 73(SD 20.1), demonstrating that the cohort overall did not regain their pre-morbid functional levels. FES was negatively correlated with both 3-month MBI and PMS with coefficients -0.592 and -0.523 respectively (p<0.001). FES was negatively associated with 3-month MBI and PMS in the multiple linear regression model, having adjusted for demographics, comorbidities, pre-fracture MBI and PMS, MMSE, geriatric depression scale, and post-operative weight-bearing status, with corresponding βs -0.26(95%CI -0.49 to -0.02;p=0.032) and -0.03(95%CI -0.06 to -0.00;p=0.044). Conclusion: FoF is a potentially modifiable factor linked to adverse functional outcomes in hip fracture rehabilitation, indicating the necessity to address falls self-efficacy as a major component of assessment and intervention, whilst further exploring the local validity and applicability of various instruments measuring FoF. Further studies need to be conducted on the evolving patterns of FoF over time and its impact on longer-term functional and psychosocial outcomes.