Hip injuries and pain sustained in older adults are a result of pathology (e.g., osteoarthritis or rheumatoid arthritis), or can result from injuries received after falling (e.g., hip fractures). According to the U.S. Centers for Disease Control and Prevention, hip fractures are responsible for increased nursing home admission, increased mortality, and long-term functional impairment. It is well-reported in the literature that many fall-related deaths are due to complications that occur after receiving a hip fracture.
There is also evidence that people who sustain hip fractures have co-morbidities that relate to functional impairments and frailty. Due to this unfortunate reality, finding ways to effectively measure functional mobility to reduce the number of falls, and therefore hip injuries, is warranted.
A comprehensive geriatric assessment (CGA) entails use of the Short Physical Performance Battery (SPPB), which includes 10-second standing balance performed in three positions (side-by-side, semi-tandem, and tandem), 4-meter timed speed, and five-time chair sit-to-stand. A summed score is created, ranging from zero to 12 based upon the performance of these tasks. Internal consistency has been reported for the SPPB, Cronbach’s alpha = .76.
Other mobility measures used to assess functionality in ADLs are the Timed Up and Go test (TUG), the Barthel Index, and the Nottingham Extended I-ADL scale. Charnley’s Hip Score, the analog pain scale, and a health-related quality of life measure such as the SF-36 should be included as part of the overall assessment.
Measures of gait, cognitive function, and emotional state such as depression can be assessed using a dynamic gait trainer, the Dementia Rating Scale, and Mini-Mental State Examination or Geriatric Depression Scale (or similar), respectively. All of these functional tools are well-established as reliable and valid measurements for which they were intended.
For those who want “just a functional measure for the hip,” we will not leave you disappointed. The Oxford Hip Score is one such measure. The Oxford Hip Score is a 12-item patient self-report that’s been used to assess function and pain in patients who are undergoing a total hip replacement. One caution: since its inception in 1996, the scoring system has been updated to eventually make interpretation and comparison of results less confusing.
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