Hip fracture patients experience prolonged reduced quality of life.

This shows a research collaboration between Nordland Hospital, the Centre for Clinical Documentation and Evaluation (SKDE), and the National Hip Fracture Register.

The study was conducted using registry data from the medical quality register, the National Hip Fracture Register, and linked with data from the Norwegian Patient Register and Statistics Norway.

The researchers also found that several factors influence which hip fracture patients receive and return PROM questionnaires (PROM = Patient Reported Outcome Measures). This is a registry form that measures how patients perceive their own health, illness, and the effects of the treatment they have received.

Age, gender, and morbidity play a role 

By analysing the PROM data, the researchers behind the study found that patients reported lower quality of life over a period of 36 months. Older age, male gender, increased morbidity, lower socioeconomic status, and residing in a healthcare institution were associated with a lower proportion of patients receiving and returning questionnaires for analysis. Furthermore, patients with these characteristics reported lower health-related quality of life.

— This results in a triple bias, where the same factors pull in the same direction three times. Such biases pose a risk of overestimating the measured health-related quality of life in hip fracture patients in observational studies based on registry data. This highlights the need to use statistical modelling to adjust for these biases when analysing such data, so that the results can better reflect the actual health status of the entire patient group, says Cato Kjærvik. 

He is one of the researchers behind the study, a researcher at SKDE, and a consultant at the surgical-orthopaedic department, Nordland Hospital, Vesterålen. He believes that the study provides insight into the consequences of a hip fracture on quality of life, as well as the limitations and strengths of PROMs as a tool for evaluating patient outcomes after hip fractures. 

— These findings can also be transferred to other similar, older patient groups. One should expect to see corresponding mechanisms for bias in other similar patient groups. 

Should influence patient follow-up 

The disparities in quality of life after hip fractures based on age, gender, morbidity, and socioeconomic status — despite statistical adjustment for the relevant factors — are findings that must be taken into account in clinical practice, believes Cato Kjærvik. 

— What can the healthcare service contribute to level out these differences? 

— The research results have the potential to influence the follow-up of patients and the interpretation of data from hip fracture patients both nationally and internationally, says Kjærvik. 

The research was published on 1 April 2024 in the prestigious journal Bone & Joint Journal under the title “Patient-reported outcome measures in hip fracture patients”. 

The research collaboration between Nordland Hospital, the research environment at SKDE, and the National Hip Fracture Register has resulted in several published scientific articles in this field.

Read more research findings on hip fracture patients: 

• This shortens the life of hip fracture patients 
• The registers contain an enormous amount of knowledge