A portable neuromuscular function assessment for studying recovery from hip fracture

Objective: To determine the reliability and applicability of a portable, performance-based assessment of balance and gait in characterizing recovery after hip fracture in elderly persons. Design: The assessment was developed as part of a prospective, observational study of hip fracture recovery among elderly persons. Reliability was assessed in 24 subjects by administering the tasks twice within 1 week. Setting: In-home assessments were performed on community-dwelling elderly. Patients: Randomly selected subset of hip fracture patients, 65 years and older, admitted to 1 of 8 Baltimore hospitals between January 1990 and June 1991. Twenty-four patients were asked to repeat the gait and balance assessment at the 6-month follow-up visit. Main Outcome Measures: The evaluation included: (1) sitting balance, (2) arising from an armless chair, (3) standing balance, eyes open and closed, (4) one leg standing balance, (5) sitting down, (6) gait, and (7) range of motion in the knee and hip. Results: The assessment took 15 to 20 minutes to complete and was feasible to perform for recent hip fracture patients, except for single leg standing. Interrater reliability was good for most tasks, with agreement between evaluators being 74% to 100% for tasks involving standing balance, chair rise, gait, and range of motion; kappas = 0.4 to 0.9. Single leg standing, knee extension, and balance while sitting were the least reliable tasks; 59% to 73% agreement, kappas = 0.1 to 0.4. Conclusions: We conclude that this instrument is a reliable measure of physical ability that will provide a clear indication of mobility impairment in patients recovering from a hip fracture. This instrument should prove useful in assessing patients with lower extremity difficulties. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.