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Loss of health related quality of life following low-trauma fractures in the elderly.

Tarride JE, Burke N, Leslie WD, Morin SN, Adachi JD, Papaioannou A, Bessette L, Brown JP, Pericleous L, Muratov S, Hopkins RB - BMC Geriatr (2016)

Bottom Line: The HUI-2, a validated HRQoL instrument, allows the calculation of health utility where 0 represents death and 1 the best imaginable health state.Of the 6 HUI-2 domains, mobility had the largest impact on change in HRQoL.Regression analysis indicated that living with a musculoskeletal disorder or a neurological condition and living in LTC were associated with greater decrements in utility following a fracture.

View Article: PubMed Central - PubMed

Affiliation: Programs for Assessment of Technology in Health (PATH), St. Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada. tarride@mcmaster.ca.

ABSTRACT

Background: To estimate the long-term change in health related quality of life (HRQoL) following low-trauma fractures among individuals receiving home care (HC) services or living in long-term care (LTC) facilities using linked healthcare administrative data from Ontario, Canada.

Methods: HRQoL was estimated using the Health Utility Index (HUI-2) with the InterRai Minimum Data Set (MDS), a mandatory questionnaire for LTC and HC in the province of Ontario (population 14 million). The HUI-2, a validated HRQoL instrument, allows the calculation of health utility where 0 represents death and 1 the best imaginable health state. For reference, the HUI-2 utility value for Canadians aged 80-84 years is 0.61 and the minimal clinically important difference is 0.03. The MDS was linked to Ontario acute care databases for fiscal years 2007-2011 to identify low-trauma fractures using ICD-10-CA codes. Regression models were used to identify predictors of change in HRQoL from pre-fracture levels to 3 years post fracture for several populations. Low-trauma fractures included hip, humerus, vertebral, wrist, multiple and other.

Results: Twenty-three thousand six-hundred fifty-five unique patients with low-trauma fractures were identified with pre- and post-fracture HRQoL assessments, of which 5057 individuals had at least 3 years of follow-up. Compared to patients receiving HC services (N = 3303), individuals residing in LTC (N = 1754) were older, taking more medications, and had more comorbidities. LTC patients had more hip fractures (49 % of total versus 29 %). For all fracture types, HRQoL decreased immediately following fracture. Although levels rebounded after the first month, HRQoL up to 36 months never returned to pre-fracture levels even for non-hip fracture. For both HC and LTC cohorts, clinically important and statistically significant decreases in HUI-2 utility scores were observed 36 months post fracture. Of the 6 HUI-2 domains, mobility had the largest impact on change in HRQoL. Regression analysis indicated that living with a musculoskeletal disorder or a neurological condition and living in LTC were associated with greater decrements in utility following a fracture.

Conclusions: Based on the analysis of one of the largest studies on HRQoL to date, among individuals living in LTC facilities or receiving HC services, fractures have a significant permanent impact on HRQoL up to 3 years following fracture.

No MeSH data available.


Related in: MedlinePlus

Mean Health Related Quality of Life (HRQoL) Pre- and Post-Fracture, by Type of Fracture (Home Care and Long-term Care cohorts combined)
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Fig2: Mean Health Related Quality of Life (HRQoL) Pre- and Post-Fracture, by Type of Fracture (Home Care and Long-term Care cohorts combined)

Mentions: Figure 2 presents the unadjusted HUI-2 utility scores over time from pre-fracture to 36 months post-fracture by type of fracture for the entire study population (HC and LTC cohorts combined). The overall pattern shows a drop in HRQoL immediately following the fracture and a rebound after the first month. However, for all types of fractures, HRQoL never return to pre-fracture levels in the 3 year post-fracture period (Fig. 2). Among the various types of fractures, individuals who experienced a hip fracture had the lowest pre- and post-fracture HUI-2 utility scores. Figure 3 presents more detailed information on mean HRQoL values and their associated confidence intervals for each time point associated with each type of fracture.Fig. 2


Loss of health related quality of life following low-trauma fractures in the elderly.

Tarride JE, Burke N, Leslie WD, Morin SN, Adachi JD, Papaioannou A, Bessette L, Brown JP, Pericleous L, Muratov S, Hopkins RB - BMC Geriatr (2016)

Mean Health Related Quality of Life (HRQoL) Pre- and Post-Fracture, by Type of Fracture (Home Care and Long-term Care cohorts combined)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837505&req=5

Fig2: Mean Health Related Quality of Life (HRQoL) Pre- and Post-Fracture, by Type of Fracture (Home Care and Long-term Care cohorts combined)
Mentions: Figure 2 presents the unadjusted HUI-2 utility scores over time from pre-fracture to 36 months post-fracture by type of fracture for the entire study population (HC and LTC cohorts combined). The overall pattern shows a drop in HRQoL immediately following the fracture and a rebound after the first month. However, for all types of fractures, HRQoL never return to pre-fracture levels in the 3 year post-fracture period (Fig. 2). Among the various types of fractures, individuals who experienced a hip fracture had the lowest pre- and post-fracture HUI-2 utility scores. Figure 3 presents more detailed information on mean HRQoL values and their associated confidence intervals for each time point associated with each type of fracture.Fig. 2

Bottom Line: The HUI-2, a validated HRQoL instrument, allows the calculation of health utility where 0 represents death and 1 the best imaginable health state.Of the 6 HUI-2 domains, mobility had the largest impact on change in HRQoL.Regression analysis indicated that living with a musculoskeletal disorder or a neurological condition and living in LTC were associated with greater decrements in utility following a fracture.

View Article: PubMed Central - PubMed

Affiliation: Programs for Assessment of Technology in Health (PATH), St. Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada. tarride@mcmaster.ca.

ABSTRACT

Background: To estimate the long-term change in health related quality of life (HRQoL) following low-trauma fractures among individuals receiving home care (HC) services or living in long-term care (LTC) facilities using linked healthcare administrative data from Ontario, Canada.

Methods: HRQoL was estimated using the Health Utility Index (HUI-2) with the InterRai Minimum Data Set (MDS), a mandatory questionnaire for LTC and HC in the province of Ontario (population 14 million). The HUI-2, a validated HRQoL instrument, allows the calculation of health utility where 0 represents death and 1 the best imaginable health state. For reference, the HUI-2 utility value for Canadians aged 80-84 years is 0.61 and the minimal clinically important difference is 0.03. The MDS was linked to Ontario acute care databases for fiscal years 2007-2011 to identify low-trauma fractures using ICD-10-CA codes. Regression models were used to identify predictors of change in HRQoL from pre-fracture levels to 3 years post fracture for several populations. Low-trauma fractures included hip, humerus, vertebral, wrist, multiple and other.

Results: Twenty-three thousand six-hundred fifty-five unique patients with low-trauma fractures were identified with pre- and post-fracture HRQoL assessments, of which 5057 individuals had at least 3 years of follow-up. Compared to patients receiving HC services (N = 3303), individuals residing in LTC (N = 1754) were older, taking more medications, and had more comorbidities. LTC patients had more hip fractures (49 % of total versus 29 %). For all fracture types, HRQoL decreased immediately following fracture. Although levels rebounded after the first month, HRQoL up to 36 months never returned to pre-fracture levels even for non-hip fracture. For both HC and LTC cohorts, clinically important and statistically significant decreases in HUI-2 utility scores were observed 36 months post fracture. Of the 6 HUI-2 domains, mobility had the largest impact on change in HRQoL. Regression analysis indicated that living with a musculoskeletal disorder or a neurological condition and living in LTC were associated with greater decrements in utility following a fracture.

Conclusions: Based on the analysis of one of the largest studies on HRQoL to date, among individuals living in LTC facilities or receiving HC services, fractures have a significant permanent impact on HRQoL up to 3 years following fracture.

No MeSH data available.


Related in: MedlinePlus