Quality of life in postoperative Japanese hip fracture patients: a hospital-based prospective study

Summary

This study aimed to study quality of life (QOL) in postoperative Japanese hip fracture patients. Although QOL in Japanese patients recovered to pre-fracture levels 1 year following hospitalization, the recovery varied and was associated with physical factors and living arrangements.

Introduction

The aim of this study was to investigate quality-of-life (QOL) changes in postoperative Japanese hip fracture patients.

Methods

Subjects were 113 hip fracture patients recruited and followed for 1 year following hospitalization. QOL was assessed using the Euro-QOL, which consists of the health status part (EQ-5D) and the visual analogue scale (EQ-VAS). Factors associated with change in QOL (calculated by subtracting pre-fracture score from the score at 1 year following hospitalization) were determined by multiple linear regression analysis.

Results

Of 81 patients who did not exhibit severe cognitive decline, 50 completed the follow-up surveys and were included for analysis. The mean difference from baseline was 0.035 (standard deviation = 0.254) for EQ-5D, and 17.0 (22.0) for EQ-VAS. Age, fracture type and residence status were significantly associated with a change in EQ-5D score. Cognitive function, activities of daily living and household help were significantly associated with a change in EQ-VAS score.

Conclusions

Contrary to previous studies from western countries, we found that QOL in Japanese patients recovered to pre-facture levels 1 year following hospitalization. This change varied between patients, and was associated with both physical factors and living arrangements.     

A comparison of the validity of two indirect utility instruments as measures of postoperative recovery

Background

Cost-effectiveness analyses of surgical interventions require valid measures of postoperative recovery. The objective of this study was to compare the validity of two indirect utility instruments, the Short Form 6D (SF-6D) and EuroQol 5D (EQ-5D), as measures of postoperative recovery.

Materials and methods

A prospective cohort of patients undergoing elective colorectal resection at two university-affiliated institutions from October 2012–October 2013 completed the SF-6D and EQ-5D (including the EQ-visual analog scale [EQ-VAS]) at baseline (before surgery), and at 4 and 8 wk after surgery. Responsiveness and construct validity were assessed through a priori hypotheses.

Results

A total of 165 patients were included. The SF-6D was the most responsive to the expected postoperative changes at 4 and 8 wk compared with the EQ-5D and the EQ-VAS. The 4-wk SF-6D, EQ-5D, and EQ-VAS discriminated between patients with and without complications after controlling for confounders with adjusted mean differences of −0.070 (95% confidence interval [CI] −0.126 to −0.015), −0.133 (95% CI −0.231, −0.030), and −7.91 (95% CI −14.77, −1.04), respectively. Mean SF-6D and EQ-5D values were significantly different from the US population norms at all time points, but the magnitude of change was highest for the SF-6D. The strength of correlation between all three instruments was moderate at all time points (r = 0.550–0.684, all P < 0.05).

Conclusions

The SF-6D preference-based health index appears to be a more valid measure of postoperative recovery than the EQ-5D and EQ-VAS in surgical cost-effectiveness analyses.     

Zoledronic acid results in better health-related quality of life following hip fracture: the HORIZON�CRecurrent Fracture Trial

Summary

This study evaluated the benefits of ZOL versus placebo on health-related quality of life (HRQoL) among patients from HORIZON?CRFT. At month?24 and end of the study visit, ZOL significantly improved patients?? overall health state compared to placebo as assessed by the EQ-5D VAS.

Introduction

To evaluate the benefits of zoledronic acid (ZOL) versus placebo on health-related quality of life (HRQoL) among patients from The Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Recurrent Fracture Trial (HORIZON?CRFT).

Methods

In this randomized, double-blind, placebo-controlled trial, 2,127 patients were randomized to receive annual infusion of ZOL 5?mg (n?=?1,065) or placebo (n?=?1,062) within 90?days after surgical repair of low-trauma hip fracture. HRQoL was measured using EQ-5D Visual Analogue Scale (VAS) and utility scores (EuroQol instrument) at months?6, 12, 24, 36, and end of the study visit. Analysis of covariance model included baseline EQ-5D value, region, and treatment as explanatory variables.

Results

At baseline, patients (mean age 75?years; 24% men and 76% women) were well matched between treatment groups with mean EQ-5D VAS of 65.82 in ZOL and 65.70 in placebo group. At the end of the study, mean change from baseline in EQ-5D VAS was greater for ZOL vs. placebo in all patients (7.67?±?0.56 vs. 5.42?±?0.56), and in subgroups of patients experiencing clinical vertebral fractures (8.86?±?4.91 vs. ?1.69?±?3.42), non-vertebral fractures (5.03?±?2.48 vs. ?1.07?±?2.16), and clinical fractures (5.19?±?2.25 vs. ?0.72?±?1.82) with treatment difference significantly in favor of ZOL. EQ-5D utility scores were comparable for ZOL and placebo groups, but more patients on placebo consistently had extreme difficulty in mobility (1.74% for ZOL vs. 2.13% for placebo; p?=?0.6238), self-care (4.92% vs. 6.69%; p?=?0.1013), and usual activities (10.28% vs. 12.91%; p?=?0.0775).

Conclusion

ZOL significantly improves HRQoL in patients with low-trauma hip fracture.     

Sequential change in quality of life for patients with incident clinical fractures: a prospective study

Summary  Health-related quality of life in elderly women with sustained incident fractures was assessed prospectively for 1 year, using the EuroQol standard. Loss of QOL was more severe in patients after hip or vertebral fractures than those with wrist fracture. QOL was not completely restored in patients suffering from hip fracture. Introduction  Osteoporosis-related fractures decrease mobility, social interaction, and emotional well-being. All of these characteristics determine health-related quality of life (HR-QOL). In this study, we assessed HR-QOL in elderly women following incident clinical fractures. Methods  Thirty-seven patients with hip fractures (mean age 76.1 years), 35 with vertebral fractures (mean age 72.6 years), and 50 with wrist fractures (mean age 68.6 years) were enrolled. HR-QOL was prospectively measured using EuroQol (EQ-5D) before the fracture, 2 weeks, 3 months, 6 months, and 1 year after the fracture. Results  During the observation period, reduction of EQ-5D values was greatest in the hip fracture group. In the wrist fracture group, EQ-5D values at 6 months after the fracture showed recovery; however, in the hip and vertebral fracture groups, recovery was significantly lower than before the fracture. One year after the fracture, EQ-5D values were not significantly different from prefracture values in the vertebral and wrist fracture groups, but remained significantly lower in the hip fracture group. Conclusions  Loss of QOL was more severe in patients after hip or vertebral fractures than in patients with wrist fracture. HR-QOL was not completely restored in patients suffering from hip fracture.     

Body Mass Index Class Is Independently Associated With Health-Related Quality of Life After Primary Total Hip Arthroplasty: An Institutional Registry-Based Study

Background

The purpose of this study was to compare the health-related quality of life (HRQoL) of patients across World Health Organization (WHO) body mass index (BMI) classes before and after total hip arthroplasty (THA).

What determines health-related quality of life in hip fracture patients at the end of acute care?—a prospective observational study

Summary

Hip fractures are associated with reduced health-related quality of life (HrQoL). We found pre-existing need of care or limited function, cognitive impairment, and depression to be independent factors associated with lower HrQoL during the postsurgical period. In contrast, joint replacement was associated with better HrQoL compared to internal fixation. Patients’ treatment should be focused on functional recovery and treatment of depression.

Introduction

The aim of the study was to identify independent factors that were correlated with health-related quality of life (HrQoL) after hip fracture.

Methods

A total of 402 patients with a mean age of 81 years suffering from a hip fracture were included in this prospective, observational cohort study. HrQoL (determined by the EuroQol instrument) was measured at admission and at discharge from an acute care hospital. Independent factors correlated with HrQoL at discharge and changes from pre-fracture to discharge were determined using multivariate analyses. The influence of antidepressants was evaluated by an ANOVA with repeated measurements.

Results

Need of care prior to fracture was the most important determinant of EQ-5D index at discharge (ß?=??0.359, p?=?0.003). Additionally, low Mini Mental Status Examination (MMSE) was associated with a lower EQ-5D index at discharge (MMSE 0–9: ß?=??0.238, p <0.001; MMSE 10–19: ß?=??0.294, p <0.001) and a greater decrease in EQ-5D during hospitalisation (MMSE 10–19: ß?=?0.281, p <0.001), while joint replacement (compared to internal fixation) was associated with a higher EQ-5D index (ß?=?0.188, p?=?0.002) and a lower decrease in the index (ß?=??0.216, p?=?0.003). EQ VAS values at discharge were correlated with pre-fracture Barthel Index (ß?=?0.253, p <0.001) and Geriatric Depression Scale scores (ß?=??0.135, p?=?0.026). Depressive patients on antidepressants demonstrated less of a decrease in the EQ-5D index compared to patients not receiving medication (F?=?2.907, p?=?0.090).

Conclusions

Acute care of hip fracture patients should be focused on functional recovery and treatment of depression. When the preferred surgical strategy is unclear, joint replacement should be considered.     

Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women

Summary

Among 50,461 postmenopausal women, 1,822 fractures occurred (57% minor non-hip, non-vertebral [NHNV], 26% major NHNV, 10% spine, 7% hip) over 1?year. Spine fractures had the greatest detrimental effect on EQ-5D, followed by major NHNV and hip fractures. Decreases in physical function and health status were greatest for spine or hip fractures.

Introduction

There is growing evidence that NHNV fractures result in substantial morbidity and healthcare costs. The aim of this prospective study was to assess the effect of these NHNV fractures on quality of life.

Methods

We analyzed the 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the Global Longitudinal study of Osteoporosis in Women (GLOW). Health-related quality of life (HRQL) was analyzed using the EuroQol EQ-5D tool and the SF-36 health survey.

Results

Among 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1?year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The number of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for those with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Statistically significant reductions in SF-36 physical function were found for spine fractures, and were borderline significant for major NHNV fractures.

Conclusion

This prospective study shows that NHNV fractures have a detrimental effect on HRQL. Efforts to optimize the care of osteoporosis patients should include the prevention of NHNV fractures.     

A comparative prospective cohort health economic analysis comparing ankle fusion,isolated great toe fusion and hallux valgus surgery

Background

This study assessed the health economics and outcomes of three common foot and ankle operations.

Comparison of health state utility measures and disabilities of arm,shoulder and hand questionnaire scores in bilateral hand amputees

Bilateral hand amputation (BHA) is a life-changing event that can result in a great degree of loss of function. Prosthetic limb replacement and composite tissue allotransplantation are the treatment options. Understanding the BHA in terms of economic utility will help direct future research and upgrading in healthcare delivery. This is a cross-sectional study in 32 BHA who have completed a minimum of six months after wound healing. The primary objective was to assess the convergent validity of three different health utility (HU) derivation methods, namely the time trade-off (TTO), EuroQol questionnaire (EQ-5D-5L), and EuroQol visual analog scale (EQ-VAS) among BHA. The secondary objective was to correlate the disabilities of arm, shoulder and hand (DASH) scores with the HU scores and see whether the DASH score predicts the HU scores derived by different methods. The mean (SD) HU scores for TTO, VAS, and EQ-5D-5L were 0.34 (0.25), 0.61 (0.25), and 0.46 (0.20), respectively. HU derived by the TTO method displayed a weak correlation with EuroQol-based derivatives (EQ-VAS & EQ-5D-5L). But there was a moderate correlation between values by EQ-VAS & EQ-5D-5L. Hence, the EuroQol HU derivative is preferable to TTO. The mean (SD) of the DASH score was 48.4 (22.9). There was a strong correlation between the DASH scores and HU derived by different methods. Also, the DASH score is seen to be a good predictor of HU scores. This study is the first to derive HU and correlate the DASH with HU scores in the BHA scenario .     

A simple visual analog scale for pain is as responsive as the WOMAC,the SF-36, and the EQ-5D in measuring outcomes of revision hip arthroplasty: A prospective cohort study of 45 patients followed for 2 years

Background and purpose

Little is known about the comparative performance of patient-reported outcome measures in revision hip arthroplasty. We compared the performance of the WOMAC, the SF-36, the EQ-5D, and a pain-related visual analog scale (VAS) in revision hip arthroplasty.

Methods

45 patients with aseptic prosthetic loosening following primary hip arthroplasty completed the WOMAC, the SF-36, the EQ-5D, and a VAS for pain—at baseline and 2 years after revision. Responsiveness of the measures was compared with the effect size (with ≥ 0.8 being considered large). Agreement between scales measuring the same type of outcome (pain or physical function) was assessed with the Bland-Altman method.

Results

The mean preoperative scores for the pain and physical function scales of WOMAC and SF-36, EQ-5D index, and VAS for pain improved statistically significantly 2 years after revision. The effect size for the WOMAC pain was 1.7, that for SF-36 pain was 1.4, that for WOMAC physical function was 1.6, that for SF-36 physical function was 0.8, and that for EQ-5D index was 1.2. The VAS for pain had an effect size of 2.1, which was larger than that for SF-36 pain and for the EQ-5D index (p ≤ 0.03) but not for WOMAC pain (p = 0.2). The limits of agreement between WOMAC pain, SF-36 pain, and the VAS scale measuring pain—and between the WOMAC and SF-36 scales measuring physical function—were wide. Internal-consistency reliability was high for the WOMAC and SF-36 scales but low for the EQ-5D.

Interpretation

In patients with first-time revision hip arthroplasty done for aseptic loosening, the WOMAC, SF-36, and EQ-5D showed high responsiveness in measuring patient-reported outcomes and the simple VAS for pain performed equally well.In clinical research involving primary hip arthroplasty, health and quality-of-life outcomes have commonly been measured with the WOMAC and the SF-36 questionnaires. The EQ-5D is also being increasingly used, for example in some national joint registries such as the Swedish Hip Arthroplasty Register (Rolfson et al. 2011). Several studies have shown good validity, reliability, and responsiveness of patient-reported outcome measures in primary hip arthroplasty (Nilsdotter et al. 2001). Although patient-relevant outcomes with regard to primary hip arthroplasty have been studied extensively, less is known about these outcomes following revision arthroplasty. In previous studies of revision arthroplasty, pain and physical function have been evaluated with clinician-based scores such as the Harris hip score and the Merle d’Aubigné score (Lubbeke et al. 2007). A few studies have used patient-based outcome measures such as the WOMAC and SF-36 (Davis et al. 2006, Lubbeke et al. 2007). Measures that have demonstrated good responsiveness in primary hip arthroplasty do not necessarily perform similarly in revision arthroplasty. Apart from responsiveness, the length of an outcome measure is an important factor with regard to the cost of administration and the response rate, 2 essential elements when using the measure in an arthroplasty registry. Head-to-head comparisons of patient-reported outcome measures in hip arthroplasty can provide important information, but there have been very few studies of that kind.We compared the performance of the WOMAC, the SF-36, the EQ-5D, and a visual analog scale (VAS) for pain in patients undergoing revision hip arthroplasty. We hypothesized that these measures of patient-reported outcomes would vary in their responsiveness in measuring outcomes.     

Effectiveness of Teriparatide in Women Over 75 Years of Age with Severe Osteoporosis: 36-Month Results from the European Forsteo Observational Study (EFOS)

This predefined analysis of the European Forsteo Observational Study (EFOS) aimed to describe clinical fracture incidence, back pain, and health-related quality of life (HRQoL) during 18 months of teriparatide treatment and 18 months post-teriparatide in the subgroup of 589 postmenopausal women with osteoporosis aged ≥75 years. Data on clinical fractures, back pain (visual analogue scale, VAS), and HRQoL (EQ-5D) were collected over 36 months. Fracture data were summarized in 6-month intervals and analyzed using logistic regression with repeated measures. A repeated-measures model analyzed changes from baseline in back pain VAS and EQ-VAS. During the 36-month observation period, 87 (14.8 %) women aged ≥75 years sustained a total of 111 new fractures: 37 (33.3 %) vertebral fractures and 74 (66.7 %) nonvertebral fractures. Adjusted odds of fracture was decreased by 80 % in the 30 to <36–month interval compared with the first 6-month interval (P < 0.009). Although the older subgroup had higher back pain scores and poorer HRQoL at baseline than the younger subgroup, both age groups showed significant reductions in back pain and improvements in HRQoL postbaseline. In conclusion, women aged ≥75 years with severe postmenopausal osteoporosis treated with teriparatide in normal clinical practice showed a reduced clinical fracture incidence by 30 months compared with baseline. An improvement in HRQoL and, possibly, an early and significant reduction in back pain were also observed, which lasted for at least 18 months after teriparatide discontinuation when patients were taking other osteoporosis medication. The results should be interpreted in the context of an uncontrolled observational study.     

Different patient-reported outcomes in immigrants and patients born in Sweden: 18,791 patients with 1 year of follow-up in the Swedish Hip Arthroplasty Register

Background and purpose

Some patients have persistent symptoms after total hip arthroplsty (THA). We investigated whether the proportions of inferior clinical results after total hip arthroplasty—according to the 5 dimensions in the EQ-5D form, and pain and satisfaction according to a visual analog scale (VAS)—are the same in immigrants to Sweden as observed in those born in Sweden.

Methods

Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthroplasty Register (SHAR) and cross-matched with data from the National Board of Health and Welfare and also Statistics, Sweden. 18,791 operations (1,451 in immigrants, 7.7%) were eligible for analysis. Logistic and linear regression models including age, sex, diagnosis, type of fixation, comorbidity, surgical approach, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, VAS pain, and VAS satisfaction. Preoperative data and data from 1 year postoperatively were studied.

Results

Preoperatively (and after inclusion of covariates in the regression models), all immigrant groups had more negative interference concerning self-care. Immigrants from the Nordic countries outside Sweden and Europe tended to have more problems with their usual activities and patients from Europe and outside Europe more often reported problems with anxiety/depression. Patients born abroad showed an overall tendency to report more pain on the VAS than patients born in Sweden.After the operation, the immigrant groups reported more problems in all the EQ-5D dimensions. After adjustment for covariates including the preoperative baseline value, most of these differences remained except for pain/discomfort and—concerning immigrants from the Nordic countries—also anxiety/depression. After the operation, pain according to VAS had decreased substantially in all groups. The immigrant groups indicated more pain than those born in Sweden, both before and after adjustment for covariates.

Conclusion

The frequency of patients who reported moderate to severe problems, both before and 1 year after the operation, differed for most of the dimensions in EQ-5D between patients born in Sweden and those born outside Sweden.Some patients have persistent symptoms after total hip arthroplasty and are not satisfied with the procedure, with variation from a few up to as much as 30% (Greenwald 1991, Anakwe et al. 2011). In a Swedish nationwide prospective observational study, 5% of patients reported a clinically meaningful reduction in health-related quality of life (HRQoL) and EQ-5D (Rolfson et al. 2011). The outcome of THA surgery may depend on several factors such as the type and severity of the hip disease itself, patient selection, choice of implant, the quality of the surgery, and postoperative rehabilitation. Patient-related factors including ethnicity, cultural and socioeconomic background, educational level, and expectations regarding the procedure are also important (Hawker 2006, Francis et al. 2009, Krupic et al. 2013). Several studies have compared HRQoL between racial/ethnic groups and have documented important disparities, especially related to the experience and management of pain (Tamayo-Sarver et al. 2004, Ezenwa et al. 2006). Chronic pain adversely affects the HRQoL status of black Americans to a greater extent than it affects the HRQoL status of white Americans (Green et al. 2003).Patient-related factors have gained increased acceptance in assessment of the outcome of THA surgery. The Swedish Hip Arthroplasty Register (SHAR) assesses patient satisfaction, pain relief, and HRQoL using the EuroQol System (EQ-5D) (EuroQol 1990, Burstrom et al. 2001, Eisler et al. 2002, Herberts et al. 2004, Garellick et al. 2008, Rolfson et al. 2009). Understanding preoperative information about a THA may be more difficult if the patient is not sufficiently familiar with the language of the country, due to his/her immigrant status. We used the patient-reported outcomes in the SHAR to examine the hypothesis that patients who live in Sweden but have been born outside the country report worse outcome in the EQ-5D score both before and 1 year after hip replacement surgery.     

Good responsiveness with EuroQol 5-Dimension questionnaire and Short Form (36) Health Survey in 20–69 years old patients with a femoral neck fracture: A 2-year prospective follow-up study in 182 patients

BackgroundEQ-5D and SF-36 are two questionnaires used to measure health related quality of life (HRQoL). The responsiveness of these instruments has previously been evaluated in elderly populations with hip fracture but not in a younger population. The purpose was to evaluate the responsiveness of SF-36 and EQ-5D in a younger population with femoral neck fracture.Methods182 patients aged 20–69 were consecutively included. HRQoL was measured by EQ-5D and SF-36 at 4, 12 and 24 months. Pain and function were measured by Harris Hip Score (HHS) on the same occasions. The responsiveness of EQ-5D and SF-36 was evaluated by calculation of two effect sizes; standardized effect size (SES) and standardized response mean (SRM), and by analysing how changes in score correlated to changes in function and subjective state of health. External responsiveness was also evaluated by calculating receiver operating characteristic curve and area under the curve.ResultsSES was large at four months for both EQ-5D and SF-36 (1.09 and 0.83 respectively) and moderate at the 12- and 24-month follow-ups. The correlation between changes (4–24 months) in HHS and changes in HRQoL were 0.44 for EQ-5D and 0.37 for SF-36. EQ-5D and SF-36 were both more sensitive than HHS in their ability to predict subjective improvements after a hip fracture.ConclusionsThe effect sizes and the ability to follow and predict the external standard indicates that both EQ-5D and SF-36 have good internal and external responsiveness in this younger population with femoral neck fracture. The generic HRQoL questionnaires were superior to a hip-specific instrument in predicting the patients’ subjective feelings of an improved state of health. EQ-5D is simple to administer and shows similar responsiveness as SF-36 and may be sufficient to use as an outcome measure in clinical trials.     

Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur

Purpose

The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures

Methods

Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) intertrochanteric fracture were randomly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device.

Results

All patients were followed up at one, three, six and 12 months postoperatively, except for nine who died. There was no statistical difference in Parker mobility score between groups. The Gamma nail group had significantly higher Barthel Index and EuroQol-5D (EQ-5D) scores than the AMBI group at 12 months. At the same time, the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group. There were no differences in mortality, radiation time and hospital stay. Duration of the operation, incision length and hip pain occurrence were significantly less in the Gamma nail group.

Conclusions

Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw. Nevertheless, an intramedullary nail seems superior in reconstituting patients to their pre-operative state.     

Validation of the EQ-5D questionnaire in burn injured adults

Background

Health-related quality of life (HRQoL) is an important aspect of adaptation after burn. The EQ-5D is a standardized generic instrument for assessing HRQoL. Its psychometric properties in a group of burn injured individuals are, however, not known.

Methods

Seventy-eight consecutive patients admitted to a burn unit were included in a prospective longitudinal study. The participants completed the EQ-5D during acute care, and at 3, 6, and 12 months after the burn. At 6 and 12 months after the burn they also completed the Short-Form 36 Health Survey (SF-36) and the Burn Specific Health Scale-Brief (BSHS-B).

Results

High feasibility of the EQ-5D was demonstrated through a high response rate and a low proportion of missing or invalid answers. The floor and ceiling effects were small. Construct validity was demonstrated through good differentiation between health states and good discrimination of health states over time. The EQ-5D was associated with burn severity and discriminated between clinical subgroups in an expected manner. Criterion validity was demonstrated through significant correlations between the EQ-5D and subscales of the SF-36 and the BSHS-B.

Conclusions

The EQ-5D has good psychometric properties, it is short and easy to administer and thus useful in assessment of HRQoL after burn.     

Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail

Purpose

The aim of the study was to report the musculoskeletal function and health-related quality of life (HRQoL) after an unstable trochanteric fracture treated with a cephalomedullary nail.

Methods

One hundred and seventeen patients, mean age 84.1?years, were included in a 1-year prospective cohort study. Outcome measurements included musculoskeletal function according to the Short Musculoskeletal Function Assessment (SMFA) and HRQoL according to the EQ-5D.

Results

Fourteen patients (12.0?%) were reoperated on, all but one being due to a secondary lag-screw penetration/cut-out. The need for revision surgery was significantly higher after a 4-part fracture according to the Jensen–Michaelsen classification as compared to after a 3-part fracture, i.e. 17 versus 6?% (p?=?0.048). The reoperation was a hip replacement in 12 of the 14 patients, a total hip replacement (THR) in 10 and a hemiarthroplasty in 2. The SMFA dysfunction and bother indices in all patients showed a significant deterioration at 12?months compared to before the fracture, from 24.8 to 42.4 (p?p?index score decreased from 0.79 prefracture to 0.51 (p?index score of 0.58.

Conclusions

An unstable trochanteric fracture treated with a cephalomedullary nail had a substantial negative impact on the patient’s musculoskeletal function and HRQoL. The need for revision surgery was significantly higher after a 4-part fracture compared to after a 3-part fracture. The by far most common fracture complication, i.e. a secondary lag-screw penetration/cut-out, was successfully treated with a THR.     

Validation of the IOF quality of life questionnaire for patients with wrist fracture

Introduction

Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a multicentre study and compared with an osteoporosis-specific questionnaire (Qualeffo-41) and a generic questionnaire (EQ-5D).

Methods

The study included 105 patients with a recent wrist fracture and 74 sex- and age-matched control subjects. The questionnaire was administered as soon as possible after the fracture, at 6 weeks, 3 months, 6 months and 1 year after the fracture. Test–retest reproducibility, internal consistency and sensitivity to change were assessed.

Results and discussion

The results showed adequate repeatability and internal consistency of the International Osteoporosis Foundation (IOF) wrist fracture questionnaire. The discriminatory capacity between patients and control subjects was very high, with significant odds ratios for each question and domain. The IOF-wrist fracture questionnaire domain scores showed significant improvement after 3 and 6 months and some improvement from 6 months up to 1 year. The sensitivity to change was much higher for the IOF-wrist fracture total score than for Qualeffo-41 and EQ-5D.

Conclusion

In conclusion, the IOF-wrist fracture questionnaire appears to be a reliable and responsive quality of life questionnaire.     

Validity of the short musculoskeletal function assessment questionnaire in patients with a spine fracture

Purpose

The aim of this study was to validate the use of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a spine fracture.

Methods

Cross-sectional cohort of individuals that had sustained a spine fracture (C1-L5) one year earlier. Patients were asked to fill out SMFA, Oswestry Disability Index (ODI), EQ-5D-3L and EQ-VAS. Spearman’s rank correlation coefficient (rho) was used to assess convergent validity for each patient-reported outcome measure (PROM). Bland–Altman plots were used to assess PROM agreement.

Results

82 patients completed all questionnaires. The correlations between SMFA Dysfunction and Bother indices and ODI were 0.89 and 0.86, with EQ-5D-3L index 0.89 and 0.80, and with EQ-VAS 0.80 and 0.73, respectively. The correlation for separate categories of the SMFA dysfunction index (daily activities, emotional status, arm and hand function, mobility) ranged between 0.71–0.87 for ODI, 0.72–0.84 for EQ-5D-3L index, and 0.67–0.77 for EQ-VAS. A selection of the ten items of SMFA that had the highest correlations with ODI resulted in a correlation of 0.91. The agreements between SMFA indices and ODI in Bland–Altman plots were good with small differential biases and minimal proportional biases, but worse for SMFA and EQ-5D-3L index and EQ-VAS.

Conclusion

The SMFA indices are highly correlated with ODI in patients with a spine fracture. The Dysfunction index and Bother index, or selected SMFA items, may be used to assess outcome in patients with spine fractures as an alternative to ODI.

     

Quality of life,resource use,and costs related to hip fracture in Estonia

Summary

We assessed the impact of hip fracture on health-related quality of life (HRQoL) and costs in Estonia. The mean 18-month HRQoL loss in quality adjusted life years (QALY) was estimated at 0.31, and the average cumulative cost from a societal perspective was 8146 euros per hip fracture patient.

Introduction

The aim of this study is to estimate the impact of hip fracture on HRQoL, resource consumption, and cost over 18 months after the fracture among individuals aged over 50 in Estonia.

Methods

A cohort of 205 hip fracture patients ≥50 years was followed up for 18 months. HRQoL was estimated before fracture (recall), after fracture, and at 4, 12, and 18 months using the EQ-5D instrument. Health care utilization and costs were obtained from a public health insurance fund database; social, informal, and indirect costs were estimated using patient-reported data.

Results

Hip fracture resulted in the mean 18-month HRQoL loss of 0.31 QALYs. The mean 18-months cumulative cost of hip fracture from a societal perspective was estimated at 8146 (95 % CI 6236–10717) euros per patient. Most of the cost was related to health care (56 %) and informal care (33 %), while social care contributed only 5 %. Utilization of outpatient rehabilitation and nursing care was low (8 % of patients).

Conclusions

The impact of hip fracture on HRQoL and cost was substantial. Despite appropriate inpatient care, utilization of rehabilitation, nursing care, and social care were low and potentially insufficient to meet the needs of patients with low HRQoL. The shortfall may partially explain a remarkably high use of informal care.