Persistent Pain in Frail Older Adults After Hip Fracture Repair

Authors

  • Cynthia Herrick BA,

    1. From the *Department of Internal Medicine, Program in Physical Therapy, and Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri.
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  • Karen Steger-May MA,

    1. From the *Department of Internal Medicine, Program in Physical Therapy, and Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri.
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  • David R. Sinacore PhD,

    1. From the *Department of Internal Medicine, Program in Physical Therapy, and Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri.
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  • Marybeth Brown PhD,

    1. From the *Department of Internal Medicine, Program in Physical Therapy, and Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri.
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  • Kenneth B. Schechtman PhD,

    1. From the *Department of Internal Medicine, Program in Physical Therapy, and Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri.
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  • Ellen F. Binder MD

    1. From the *Department of Internal Medicine, Program in Physical Therapy, and Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri.
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  • Funded by National Institutes of Health, National Institute on Aging Grant R01 AG15795-02, General Clinical Research Center Grant MO1 RR00036, and The Barnes-Jewish Hospital Foundation

Ellen F. Binder, MD, Division of Geriatrics and Nutritional Sciences, Washington University School of Medicine, 4488 Forest Park Blvd., Suite 201, St. Louis, MO 63108. E-mail: ebinder@im.wustl.edu

Abstract

Objectives: To identify factors associated with persistent hip pain in elderly hip fracture patients with physical frailty.

Design: Cohort study.

Setting: Community-based study conducted at academic medical center.

Participants: Eighty-eight men and women (mean age±standard deviation 80±7 years) with a recent hip fracture (mean 14.5±4.8 weeks after hip fracture repair) and physical frailty, defined as a modified Physical Performance Test Score between 12 and 28, enrolled in an exercise intervention trial.

Measurements: Dependent variable was self-report of moderate to severe regional hip pain in the week preceding the baseline interview. Independent variables were self-reported demographic information, health characteristics, and activity of daily living (ADL) function; Yesavage Mood Score (YMS); 36-item Short Form percentile scores; and objective measurements of lower extremity strength, range of motion, balance, and gait.

Results: Forty-two percent of the sample reported moderate or severe hip pain at the baseline assessment. Moderate/severe pain was related to difficulty with ADL performance and multiple measures of quality of life. Variables independently associated with moderate/severe hip pain were frequency of pain medication use (adjusted odds ratio (AOR)=5.75, 95% confidence interval (CI)=2.23–14.82, P=.003), YMS score (AOR=2.69, 95% CI=1.18–6.12, P=.02), and knee extension at 60°/s in the fractured limb (AOR=0.96, 95% CI=0.92–1.0, P=.05, model coefficient of determination=0.34).

Conclusion: Persistent hip pain is a frequent symptom in frail elderly community-dwelling hip fracture patients. Pain medication use, symptoms of depression, and skeletal muscle weakness of the fractured leg are independent correlates of moderate to severe hip pain in this patient population. Clinicians should assess for, and address, persistent pain in this patient population.

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