Heather L Mutchie1, Denise L Orwig1, Brock Beamer2,3, Vincent Conroy4,5, Jack Guralnik1, Jay Magaziner1, Ann L Gruber-Baldini1. 1. Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. 2. Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore. 3. Gerontology Research, Education, and Clinical Center (GRECC) at Baltimore Veterans Affairs Medical Center, Baltimore, Maryland. 4. Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore. 5. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore.
Abstract
BACKGROUND AND PURPOSE: Preventing subsequent falls in persons recovering from hip fracture is paramount. The Four Square Step Test (FSST) is a fast, easy measure of dynamic balance, with times more than 15 seconds previously associated with multiple fall risk in older adults. This study investigates among hip fracture patients (1) FSST performance, and how (2) unique population characteristics (such as fracture side) and (3) cognition impact FSST performance. METHODS: Patients with hip fracture (n = 40) 60 years and older came from an ancillary study to a larger randomized controlled trial testing two 16-week in-home physical therapy interventions after completion of usual care rehabilitation. Baseline measurers included: FSST, demographics, fracture characteristics, Modified Mini-Mental State Examination (3MS), Hooper Visual Organization Test (HVOT), and Trails Making Tests (TMT) A and B. RESULTS: Of 40 patients with hip fracture, 13 did not complete the FSST at baseline and were significantly older (P = .040) and performed worse on cognitive tests (3MS, HVOT, TMT-B; P < .05). Mean FSST time was 24.3 ± 13.1 seconds for the other 27, of whom 7 finished in less than 15 seconds. A significant 3-way interaction was observed, such that those with left-side pertrochanteric fractures who performed poorly on the HVOT did significantly worse on the FSST (P < .01, R2 = 0.93). DISCUSSION: Almost one-third of patients with hip fracture could not perform the FSST after completing usual care rehabilitation. Inability to perform the FSST was not random, as those without the FSST were physically and cognitively worse than those who did perform the FSST. Among those who could attempt the FSST, few performed well. Cognitive ability related to spatial orientation and fracture characteristics such as fracture side and fracture type has a synergistic effect on FSST performance. CONCLUSIONS: This is one of the first studies to assess the FSST in a population with hip fracture. At 4 months after hip fracture, most patients cannot perform the FSST in less than 15 seconds. Fracture side and fracture type appear important to FSST performance, as does cognition. More work needs to be done longitudinally to study the FSST in patients with hip fracture.
BACKGROUND AND PURPOSE: Preventing subsequent falls in persons recovering from hip fracture is paramount. The Four Square Step Test (FSST) is a fast, easy measure of dynamic balance, with times more than 15 seconds previously associated with multiple fall risk in older adults. This study investigates among hip fracture patients (1) FSST performance, and how (2) unique population characteristics (such as fracture side) and (3) cognition impact FSST performance. METHODS: Patients with hip fracture (n = 40) 60 years and older came from an ancillary study to a larger randomized controlled trial testing two 16-week in-home physical therapy interventions after completion of usual care rehabilitation. Baseline measurers included: FSST, demographics, fracture characteristics, Modified Mini-Mental State Examination (3MS), Hooper Visual Organization Test (HVOT), and Trails Making Tests (TMT) A and B. RESULTS: Of 40 patients with hip fracture, 13 did not complete the FSST at baseline and were significantly older (P = .040) and performed worse on cognitive tests (3MS, HVOT, TMT-B; P < .05). Mean FSST time was 24.3 ± 13.1 seconds for the other 27, of whom 7 finished in less than 15 seconds. A significant 3-way interaction was observed, such that those with left-side pertrochanteric fractures who performed poorly on the HVOT did significantly worse on the FSST (P < .01, R2 = 0.93). DISCUSSION: Almost one-third of patients with hip fracture could not perform the FSST after completing usual care rehabilitation. Inability to perform the FSST was not random, as those without the FSST were physically and cognitively worse than those who did perform the FSST. Among those who could attempt the FSST, few performed well. Cognitive ability related to spatial orientation and fracture characteristics such as fracture side and fracture type has a synergistic effect on FSST performance. CONCLUSIONS: This is one of the first studies to assess the FSST in a population with hip fracture. At 4 months after hip fracture, most patients cannot perform the FSST in less than 15 seconds. Fracture side and fracture type appear important to FSST performance, as does cognition. More work needs to be done longitudinally to study the FSST in patients with hip fracture.
Authors: Ann L Gruber-Baldini; Sheryl Zimmerman; R Sean Morrison; Lynn M Grattan; J Richard Hebel; Melissa M Dolan; William Hawkes; Jay Magaziner Journal: J Am Geriatr Soc Date: 2003-09 Impact factor: 5.562
Authors: Lee Ashendorf; Angela L Jefferson; Maureen K O'Connor; Christine Chaisson; Robert C Green; Robert A Stern Journal: Arch Clin Neuropsychol Date: 2008-02-21 Impact factor: 2.813