Meaningful Improvement in Gait Speed in Hip Fracture Recovery

• Published in: Journal of the American Geriatrics Society (JAGS) 2011-09, Vol.59 (9), p.1650-1657
• Main Authors: Alley, Dawn E., Hicks, Gregory E., Shardell, Michelle, Hawkes, William, Miller, Ram, Craik, Rebecca L., Mangione, Kathleen K., Orwig, Denise, Hochberg, Marc, Resnick, Barbara, Magaziner, Jay
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Female; Fractures; Gait; General aspects; Hip Fractures - rehabilitation; Hip joint; Humans; meaningful change; Medical sciences; minimum clinical difference; Miscellaneous; Mobility; physical function; physical performance measures; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recovery of Function; Walking
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2011.03560.x

OBJECTIVES: To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self‐reported mobility. DESIGN: Secondary longitudinal data analysis from two randomized controlled trials SETTING: Twelve hospitals in the Baltimore, Maryland, area. PARTICIPANTS: Two hundred seventeen women admitted with hip fracture. MEASUREMENTS: Usual gait speed and self‐reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. RESULTS: Effect size–based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor‐based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39–0.62) and specificity (0.57–0.76) for improvements in self‐reported mobility. CONCLUSION: Results from this sample of women recovering from hip fracture provide only limited support for the 0.10‐m/s cut point for substantial meaningful change previously identified in community‐dwelling older adults experiencing declines in walking abilities. Anchor‐based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self‐reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations.