Quantitative Analysis Of The Timed Up And Go In Elderly Patients Post Hip Fracture In A Sub-Acute Rehabilitation Setting

Introduction

The Timed Up and Go is an outcome measure, which has been shown to be reliable and valid to assess change in patients post hip fracture. Advances in technology have included the use of inertial sensors for the quantitative analysis of the Timed Up and Go (QTUG) and enhance the scope for harnessing information from the test. However no studies have investigated their use in hip fracture patients.

Aims and Objectives

The aim of this study was to investigate the use of the QTUG in the assessment of hip fracture patients in a sub-acute geriatric rehabilitation setting. This included investigating which components of the QTUG were sensitive to change pre and post rehab and investigating the use of the QTUG as a measure of falls risk and frailty level.

Methods

A prospective cohort study design was employed using a sample of convenience. Sixteen participants post hip fracture admitted to an inpatient post-acute rehabilitation unit were assessed on admission and at discharge using the QTUG. Individual components of QTUG (e.g. sit to stand, walk, turn time) were compared between admission and discharge. Falls risk and frailty level were also assessed using QTUG and these were compared to secondary measures of Tinetti Gait and Balance Assessment and Clinical Frailty Scale (CFS).

Results

There was a significant improvement in the main outcome measure of overall QTUG time between admission and discharge of 9.3 (95% CI 5.6 to 12.9) seconds with a p value <0.001. Each individual time component of the QTUG (sit to stand, walking, turning, stand to sit) also showed statistically significant improvements.

There was a significant improvement in both falls risk and frailty level estimates measured using the QTUG and using clinical outcome measures of Tinetti and CFS. There was a strong negative correlation between the QTUG falls risk estimate and Tinetti scores on admission (r=-0.673, p=0.004) and discharge (r=-0.764, p=0.001). There was no relationship between QTUG frailty level and CFS on admission (r=0.222, p=0.409), however there was a strong correlation on discharge (r=0.699, p=0.003).

Conclusions

The QTUG was a sensitive measure to assess for changes in functional mobility between admission and discharge for hip fracture patients. The QTUG may also provide a useful adjunct to falls risk and frailty level assessment on discharge.

Implication of Findings

Further prospective longitudinal research should be conducted to investigate the long-term outcome of hip fracture patients, using the QTUG to identify ongoing gait difficulties and to assess the predictive ability of the falls risk and frailty level estimates.