ปัจจัยก่อนการบาดเจ็บที่สัมพันธ์กับคะแนน Barthel Index ก่อนจำหน่ายใน ผู้สูงอายุหลังผ่าตัดกระดูกสะโพกหัก: การศึกษาแบบ Retrospective Cohort

Tanachonnanee Lohitkupt; Pornkanok Nimnoi

doi:10.1016/hscr.v41i1.280232

Authors

Tanachonnanee Lohitkupt Social Medicine Department, Chaophraya Yommarat Hospital
Pornkanok Nimnoi Research Division, Faculty of Medicine Siriraj Hospital, Mahidol University

DOI:

https://doi.org/10.1016/hscr.v41i1.280232

Keywords:

Hip fracture, Activities of daily living, Barthel Index, Older adults, Retrospective cohort

Abstract

Objective: Hip fracture in older adults is a major public health concern and a leading cause of functional decline and loss of independence. This study aimed to examine pre-fracture factors associated with basic activities of daily living (ADLs) at hospital discharge among older patients undergoing surgical treatment for fragility hip fracture.
Methods: This retrospective cohort study included patients aged 60 years and older who underwent surgical treatment for fragility hip fracture between January 2024 and December 2025. A total of 361 patients were analyzed. Associations between pre-fracture factors and Barthel Index scores at discharge were evaluated using descriptive statistics, univariable analysis, and multivariable linear regression to identify independent predictors
Results: Most patients were female, with a mean age of 77.43 years. The mean Barthel Index score at discharge (51.55 ± 19.87) was significantly lower than the pre-fracture score (91.33 ± 18.69; p < 0.001). In univariable analysis, age, pre-fracture Barthel Index score, cognitive impairment or dementia, and serum 25-hydroxyvitamin D level were significantly associated with Barthel Index at discharge (p < 0.05). In the final multivariable linear regression model, older age (B = −0.42; 95% CI −0.61 to −0.23; p < 0.001) and higher pre-fracture Barthel Index score (B = 0.55; 95% CI 0.46–0.64; p < 0.001) remained independently associated with Barthel Index at discharge. Comorbidities and 25-hydroxyvitamin D level were not independently associated with the outcome in the adjusted model. The final model explained 31.7% of the variance in Barthel Index at discharge (adjusted R² = 0.317).
Conclusions: Older age and pre-fracture functional status were key factors associated with basic ADLs at hospital discharge in older adults after hip fracture surgery. Early assessment of these factors may help guide care planning and rehabilitation.

References

Sing CW, Woo YC, Wong IC, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Miner Res. 2023;38(8):1064-75.

Charatcharoenwitthaya N, Nimitphong H, Wattanachanya L, et al. Epidemiology of hip fractures in Thailand. Osteoporos Int. 2024;35(9):1661-8.

Pan L, Wang H, Cao X, Ning T, Li X, Cao Y. A higher postoperative Barthel index at discharge is associated with a lower one-year mortality after hip fracture surgery for geriatric patients: a retrospective case-control study. Clin Interv Aging. 2023;18:835-43.

Dakhil S, Saltvedt I, Benth JŠ, Thingstad P, Watne LO, et al. Longitudinal trajectories of functional recovery after hip fracture. PLoS One. 2023;18(3):e0283551.

Kang MJ, Lee YK, Kim JW, et al. Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture. BMC Geriatr. 2023;23(1):112.

Mayoral AP, Ibarz E, Gracia L, Mateo J, Herrera A. The use of Barthel index for the assessment of functional recovery after osteoporotic hip fracture: one-year follow-up. PLoS One. 2019;14(2):e0212000.

Jansen CP, Klenk J, et al. Sex differences in mobility recovery after hip fracture. Front Public Health. 2024;12:1434182.

Pattison AMR, Gill SD, et al. Association of body mass index with functional outcome and rehabilitation length of stay after hip fracture: a retrospective cohort study. Arch Gerontol Geriatr. 2025;124:105444.

Chiavarini M, Ricciotti GM, Genga A, et al. Malnutrition-related health outcomes in older adults with hip fractures: a systematic review and meta-analysis. Nutrients. 2024;16(7):1069.

Bliemel C, Buecking B, Hack J, et al. Influence of Parkinson’s disease on the intermediate-term outcome of elderly patients with hip fracture. Eur J Med Res. 2020;25(1):15.

Guo J, Cheng Y, Liu W, et al. The impact of chronic kidney disease on outcomes after hip fracture surgery in elderly patients. BMC Geriatr. 2021;21(1):644.

Klotzbier TJ, König HH, Rapp K, et al. Cardiovascular health and functional recovery after hip fracture: a longitudinal study. BMC Geriatr. 2022;22(1):340.

Remelli F, Ferrara MC, Triolo F, et al. Depression and functional recovery after hip fracture in community-dwelling older adults. J Frailty Aging. 2024;13(4):470-3.

AbuAlrob H, et al. Impact of hip fracture in older adults with cognitive impairment or dementia: a scoping review. BMJ Open. 2025;15:e093893.

Granic A, Hill TR, Davies K, et al. Vitamin D status, muscle strength and physical performance decline in very old adults: a prospective study. Nutrients. 2017;9(4):379.

Pedersen TJ, Lauritsen JM. Routine functional assessment for hip fracture patients. Acta Orthop. 2016;87(4):374-9.

Kitcharanant N, Chotiyarnwong P, Thakkinstian A, et al. Prognostic factors for functional recovery at 1 year following fragility hip fracture. Clin Orthop Surg. 2024;16(1):1-9.

Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61-5.