Research Article: Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

Date Published: August 1, 2019

Publisher: Public Library of Science

Author(s): Ivan Selakovic, Emilija Dubljanin-Raspopovic, Ljiljana Markovic-Denic, Vuk Marusic, Andja Cirkovic, Marko Kadija, Sanja Tomanovic-Vujadinovic, Goran Tulic, Lars-Peter Kamolz.


Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short- and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluating sociodemographic variables, cognitive status, functional status and quality of life prior to fracture, as well as perioperative variables were performed. Follow-ups at 3 and 6 months after surgery were carried out to evaluate functional recovery. Multivariate regression models were used to assess the predictive role of handgrip strength. The mean age of the participants was 80.3 ±6.8 years. Thirty-five percent of our patients with clinically relevant hand grip strength weakness were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower EQ5D scores before fracture. Multivariate regression analysis adjusted for age and gender revealed that hand grip weakness was an independent predictor of worse functional outcome at 3 and 6 months after hip fracture for both genders and in all age populations. Our study supports the prognostic role of hand grip strength assessed at hospital admission in patients with hip fracture. Thus, clinicians should be encouraged to include hand grip assessment in their evaluation of hip fracture patients in the acute setting in order to optimize treatment of high-risk individuals.

Partial Text

Sustaining a hip fracture is considered one of the most fatal fractures for older people that leads to impaired function, and increased morbidity and mortality, and high financial liability. These facts challenge clinicians in identifying patients at risk of worse outcome early in the course of hip fracture treatment in order to set realistic rehabilitation goals, optimize perioperative care, and define optimal rehabilitation strategies in order to reduce devastating outcomes.

Our cohort consisted of 191 patients aged 66 to 97 years. The mean age was 80.3 ±6.8 years, and 77.0% of our cohort were women. The mean HGS in our cohort was 20.5 ±6.8 kg (28,7 ±6.5 kg in men, 18,1 ±4.6 kg in women). Sixty-six (34.6%) patients had clinically relevant hand grip weakness. Those patients were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, Barthel index scores and EQ5D scores before fracture. Patients with weaker grip strength were more often operated in general anesthesia (Table 1).

Our results showed that 35% of the study population had relevant clinical weakness based on hand grip strength. Patients with weak grip strength were of older age, had a higher level of comorbidity, lower cognitive level, lower functional level, and worse quality of life at admission. This clearly indicates a decline of reserve and function across multiple physiological systems in this group of patients.




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