Functional outcomes following displaced intracapsular fracture of the proximal femur in elderly people

Background The United Kingdom's elderly population and incidence of hip fracture are rising, yet outcome evidence to support optimum surgical intervention is lacking. Functional outcome is described by independence in activities of daily living (ADL), however the ideal measure to assess these activities following hip fracture is not known. The role of occupational therapy (OT) in regaining independence for patients with a hip fracture in the Leicestershire trauma unit was unclear. Therefore, the aim of this research was threefold:;To determine the optimum standardised ADL and Instrumental ADL (IADL) measures to assess outcome post hip fracture.;To observe the role of OT within the orthopaedic trauma unit in regaining independence following hip fracture.;To measure the pattern of independence and determine the effect of type of surgery on functional outcome, contributing to an evidence base.;Methods Three studies were conducted to determine the best ADL outcome measure. Firstly a study using content analysis aimed to identify a suitable IADL index. The second compared a new individualised assessment, the Canadian Occupational Performance Measure (COPM), with a traditional OT approach and the third study compared the Barthel index with a new community assessment, the Community Dependency Index (CDI). An observational study of OT intervention was completed. The impact on functional outcome of three types of surgery in two age groups was examined in the context of a randomised controlled trial. 902 functional assessments performed in patients' homes were analysed.;Main Results and Conclusion No suitable IADL measure was identified therefore a new index was developed. The Barthel Index was considered insensitive, the CDI being preferred for use whilst the COPM highlighted areas of occupational performance not included in the other assessments. The main analysis of the 902 assessments found these elderly people more dependant in IADL than ADL, but type of surgery did not significantly affect their functional outcomes. This has several implications for patients, purchasers and providers including the justification of choice of surgical intervention by orthopaedic surgeons.