Activating Older People After a Hip Fracture

The EuroQol (EQ-5D) is a patient-reported outcome measure used to evaluate the generic quality of life of the patient. The questionnaire comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 3 possible levels: no problems, some problems, and extreme problems. To obtain a total score index, the EuroQol Group provides a calculator called "EQ-5D-5L Crosswalk Index Value Calculator" which is based on several studies conducted in 6 different countries (Spain among them). Additionally, it includes the EQ visual analog scale (EQ-VAS) in which the patients self-rated her/his health on a vertical analog scale from 0 (the worst health status) to 100 (the best health status).

The Functional Independence Measure score reflects the level of assistance a person needs in activities of daily living. The measure consists of 18 items, of which 13 concern physical activities divided into four categories: self-care, sphincter control, mobility, and locomotion. The remaining five items relate to aspects of cognitive and social functioning divided in two categories: communication and social cognition. The total functional independence measure score range is between 18 and 126 points. Higher scores indicate a higher level of independence.

The SFES-I test is used to evaluate patients' fear of falling when performing ADLs. The scale consists of seven items with four possible answers corresponding to the level of concern. The total score range is from 7 to 28 points, with a higher score indicating a higher level of fear of falling. The internal consistency of the SFES-I is very high with Cronbach's α = 0.92.

The New Mobility Score (NMS) is an easy-to-administer measure of functional ability and is used worldwide as a hip fracture (HF) score. The NMS consists of three questions to measure walking mobility across daily life activities; Indoor walking, outdoor walking; and walking during shopping which evaluates the pre-fracture functional level with a score from 0 (not able to walk) to 9 (fully independent). The inter-tester reliability of the New Mobility Score is very high and can be recommended to evaluate the pre-fracture functional level in patients with acute hip fracture. The internal consistency of the NMS is good with Cronbach's α, closer to 1.

The SPMSQ this test has 10 items that assess various functions: orientation, recall memory, concentration, and calculation. Very brief but with an acceptable discriminatory capacity. The SPMSQ test has good reliability and validity. For clinical use, a cut-off of 3 appears to be most useful. When illiterate patients are assessed, it is recommended to employ a cut-off of 4 or more. The internal consistency of the SPMSQ is good with Cronbach's α, = 0,82.

The VAS Pain test is a fast and convenient way to evaluate the intensity of pain perceived by the patient. The patient indicates the perceived pain by pointing out on a physical scale a value from 0 (without pain) to 10 (maximum pain) (Boonstra, Schiphorst Preuper, Reneman, Posthumus, \& Stewart, 2008). The test-retest reliability is good with r = 0.71 for illiterate patients and r = 0.94 for literate patients.

The HADS is administered to assess the presence of anxiety and depression in both patients and caregivers. The scale consists of 14 items, each with four possible answers (0-3 points), divided into two subscales: seven items for the status of depression and the remaining items for the presence of anxiety. The maximum score of each subscale is 21 points, with scores below 11 indicating the presence of depression or anxiety. The internal consistency of the HADS is good with Cronbach's α = 0.80.

The IFIS is a simple evaluation scale consisting of five questions concerning the patient's perception of his/her general physical condition (cardio-respiratory fitness, muscular strength, agility, and flexibility). Each question has five possible answers (very poor, poor, average, good, and very good) scored from 1 to 5 points, with the highest score corresponding to the best perception of physical condition. The test-retest reliability of the IFIS, as measured by the average weighted Kappa, is 0.45.

The Zarit Burden Interview assessment includes 22 questions related to aspects of caregiver burden, including mood, physical state, economic situation, and social state, as well as the feelings of the caregiver when giving attention and care to the patient. The questions have five possible answers: 0 = never, 1 = almost never, 2 = sometimes, 3 = quite often, and 4 = almost always. The total score ranges from 0 to 88 points, with 46 points or lower indicating no burden, moderate burden between 47 and 55 points, and intense burden with 56 points or more. The internal consistency of the Zarit Burden Interview has been found to be good, with Cronbach's α = 0.86.

Oswestry test is a self-administered questionnaire specific to low back pain that measures limitations in daily activities. It consists of 10 questions with 6 answer possible each. The internal consistency of the Oswestry test with Cronbach's α, = 0.82.