medical director of the department of PM&R Nerima hikarigaoka hospital Nerima-ku, Tokyo, Japan
Objectives : In an aging society like Japan, maintaining activities of daily living (ADL) is crucial. Post-bipolar hemiarthroplasty (BHA) recovery for elderly patients with femoral neck fractures is often hindered by musculoskeletal issues. While the Cumulated Ambulation Score (CAS) is a known predictor of early postoperative mobility, we sought to identify other influential factors. This study investigates the relationship between thoracic spinal osteophytosis (TsOPH) and early ADL achievement, alongside CAS and other clinical parameters, to pinpoint new intervention targets in the acute phase.
Design: This retrospective cohort study included 64 BHA patients (Apr 2019 – Mar 2025) with intact cognitive function. Data on ADL status (dependent/independent), TsOPH, age, sex, injured side, pain, and 3-day CAS were collected. We utilized Bayesian logistic regression to identify independent predictors of early ADL achievement.
Results: Our analysis revealed that TsOPH, age, and 3-day CAS were statistically significant independent predictors of early ADL achievement. The absence of TsOPH was the strongest predictor (Odds ratio: 12.68). Higher CAS was also highly significant (Odds ratio: 1.99). Age was a significant negative predictor (Odds ratio: 0.82). Pain and other factors were not statistically significant.
Conclusion: This study is the first to identify TsOPH as the most influential independent predictor of early ADL achievement in these patients. This finding suggests that improving thoracic spine mobility could be a critical, yet overlooked, intervention target in the acute phase. Additionally, CAS serves as a valuable early screening tool reflecting pre-injury physical function. Our results highlight the need to shift focus beyond pain management to include factors like spinal mobility to improve long-term functional outcomes.
