Hip Fracture Surgery: Hand Grip Strength and Recovery Prediction

MedicalResearch.com Interview with:
Stefano Volpato MD MPH
Department of Medical Sciences, University of Ferrara
Ferrara, Italy

MedicalResearch.com: What are the main findings of the study?

Dr. Volpato: In this study we evaluated clinical value of handgrip strength  assessment in older patients admitted to the hospital for hip fracture. We observed 504 older patients admitted to 4 Italian hospitals for hip surgery, able of walking independently before fracture, and we found a strong, graded and independent association of grip strength, assessed before hip surgery, and the likelihood of functional recovery over the one-year follow-up. The findings reported in our manuscript can be summarized as:

a. handgrip strength significantly correlated with several prognostic factors traditionally considered in clinical practice, such as age, gender, neuro-psychological and functional status, comorbidity level, vitamin D plasma levels, and time before the surgical procedure;

b. logistic regression models showed that handgrip strength was directly associated with higher probability of walking recovery, both at any follow-up (incident walking recovery), and for at least 2 consecutive follow-ups (persistent walking recovery);

b. Kaplan-Meier survival estimates showed that lower grip strength was related to increased mortality after hip surgery;

c. the association between grip performance and walking recovery was clinically relevant and statistically independent of potential confounders.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Volpato:  In spite of Kaplan-Meier curves, we could not confirm a statistically significant association between low handgrip strength and probability of death in fully adjusted Cox proportional hazard models, this was probably due to the effects of other covariates.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Volpato: Grip strength is a simple clinical parameter, assessable at bedside before hip surgery, and it captures the integrated and multi-systemic effects of aging, comorbidity, disease severity, malnutrition, motivation, cognition, and body resilience on the health status of older persons. It might provide important prognostic information in order to better identify high-risk individuals who could benefit the most from intensive multi-domain intervention programs, including but not limited to earlier surgery strategy, intensive nutritional support, and rehabilitation programs.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Volpato:  and different populations. Second, to fully translate these results in clinical practice we need to establish and validate sex and age-specific cut-points to identify patients with low hand grip strength. Third, we need further studies to demonstrate that clinical and rehabilitation interventions based upon grip strength assessment might improve the functional recovery of older persons with hip fracture.

Citation:

Handgrip Strength Predicts Persistent Walking Recovery After Hip Fracture Surgery.

Savino E, Martini E, Lauretani F, Pioli G, Zagatti AM, Frondini C, Pellicciotti F, Giordano A, Ferrari A, Nardelli A, Davoli ML, Zurlo A, Lunardelli ML, Volpato S.

Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

Am J Med. 2013 Sep 17. pii: S0002-9343(13)00482-8. doi: 10.1016/j.amjmed.2013.04.017. [Epub ahead of print]