Providing insight in resilience and recovery by using fatigability and its development over time in older adults after hip fracture surgery.

Abstract

Purpose: Older hip fracture patients are often frail, complicating their recovery trajectories. Insight into patients' resilience may help in getting more understanding of their predicted recovery and adjusting their treatment plan accordingly. This study aims to assess if fatigability, calculated with the Capacity to Perceived Vitality ratio (CPV), at baseline and its development over time, can provide insight into recovery and resilience at hospital discharge.

Methods: In this prospective cohort study, patients were included from March 2022 to February 2024. Growth modelling was used to test whether there was a change in CPV over time during hospitalization and which covariables were associated with CPV. Subsequently, two logistic regression analyses were conducted to assess the role of CPV as a predictor of mobility at discharge (FAC score) and hospital complications (yes/no).

Results: CPV did not significantly change over time (estimate = 0.99; 95%CI 0.90-1.10). At baseline, men had a factor 1.6 (p = 0.01) higher CPV than women and patients with a pre-fracture KATZ-ADL 6 score of 0 had a factor 2.1 (p = 0.003) higher CPV than patients with a pre-fracture KATZ-ADL 6 score of 2 or more. The logistic regression models showed that when the intercept of CPV increased, the odds of a dependent FAC score at discharge (p = 0.002) and of developing a complication (p = 0.037) decreased.

Conclusion: CPV at baseline had predictive value for mobility at discharge and complications during hospitalization. Furthermore, there was no significant change in CPV over time, and the covariables gender and pre-fracture KATZ-ADL 6 mainly influenced the CPV at baseline.