Association between patient activation level and functional outcomes in older adults with hip fractures

Lars Tobiesen Pedersen; Jonas Ammundsen Ipsen; Inge H Bruun; Heidi Klakk Egebæk; Pernille Tanggaard Andersen; Bjarke Viberg

doi:10.1016/j.archger.2024.105472

Association between patient activation level and functional outcomes in older adults with hip fractures

Arch Gerontol Geriatr. 2024 May 3:124:105472. doi: 10.1016/j.archger.2024.105472. Online ahead of print.

Authors

Lars Tobiesen Pedersen¹, Jonas Ammundsen Ipsen², Inge H Bruun², Heidi Klakk Egebæk³, Pernille Tanggaard Andersen⁴, Bjarke Viberg⁵

Affiliations

¹ Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark Esbjerg, Denmark. Electronic address: ltpe@ucsyd.dk.
² Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
³ Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark.
⁴ Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark.
⁵ Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.

PMID: 38728823
DOI: 10.1016/j.archger.2024.105472

Abstract

Background: Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program.

Method: An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks.

Results: The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds.

Conclusion: Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.

Keywords: Functional outcomes; Hip fractures; Patient activation; Patient activation measure (PAM-13); Rehabilitation.