A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps. These traditional parameters mix different domains of PA, such as physical capacity (PC), behaviour and living environment. We examined the change of global cumulative PA measures during rehabilitation and after discharge in patients with hip or pelvic fracture and whether more ‘in-depth’ PA parameters, such as walking interval length, variability of interval length and sit-to-stand transitions and their changes during rehabilitation and 3 months after discharge might better reflect the above mentioned three clinically relevant domains of PA. This study is a secondary data analysis of a randomised controlled trial to improve PA and fall-related self-efficacy in hip or pelvic fracture patients (≥60 years) with concerns about falling. Changes of accelerometer-measured global cumulative and in-depth PA parameters (activPAL3) were analysed in an observational design before and after discharge combining both groups. For comparison, the same analyses were applied to the traditional PC measures gait speed and 5-chair-rise. Seventy-five percent of the 111 study participants were female (mean age: 82.5 (SD = 6.76) years. Daily walking duration, upright time and number of steps as aspects of global PA increased during inpatient rehabilitation as well as afterwards. The in-depth PA parameters showed differing patterns. While the total number of walking bouts increased similarly, the number of longer walking bouts decreased by 50% after discharge. This pattern was also seen for the average walking interval length, which increased by 2.34 s (95% confidence interval (CI): 0.68; 4.00) during inpatient rehabilitation and decreased afterwards below baseline level (− 4.19 s (95% CI: − 5.56; − 2.82)). The traditional PC measures showed similar patterns to the in-depth PA parameters with improvements during rehabilitation, but not at home. Our findings suggest that the in-depth PA parameters add further information to the global cumulative PA parameters. Whereas global cumulative PA parameters improved significantly during inpatient rehabilitation and after discharge, in-depth PA parameters as well as PC did not continuously improve at home. In contrast to global cumulative PA parameters the in-depth parameters seem to reflect contextual factors such as the build environment and aspects of PC, which are traditionally assessed by clinical PC measures. These in combination with digital mobility measures can help clinicians to assess the health status of fragility fracture patients, individually tailor therapy measures and monitor the rehabilitation process.

中文翻译：

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髋骨盆骨折患者住院康复期及出院后体力活动参数变化：全局和深度参数分析

越来越多的老年人因髋部和骨盆骨折而住院。它们通常会导致身体活动 (PA) 减少和行动不便。PA 可以通过佩戴在身上的传感器进行客观测量。通常，会分析全局累积 PA 参数，例如步行持续时间、直立时间和步数。这些传统参数混合了 PA 的不同领域，例如物理容量 (PC)、行为和生活环境。我们检查了髋部或骨盆骨折患者康复期间和出院后总体累积 PA 测量值的变化，以及更“深入”的 PA 参数，例如步行间隔长度、康复期间和出院后 3 个月的间隔长度和从坐到站的转变及其变化可能更好地反映上述三个 PA 的临床相关领域。本研究是一项随机对照试验的二次数据分析，旨在改善担心跌倒的髋部或骨盆骨折患者（≥60 岁）的 PA 和跌倒相关自我效能。加速度计测量的全局累积和深度 PA 参数 (activPAL3) 的变化在出院前后结合两组的观察设计中进行分析。为了比较，同样的分析被应用于传统的 PC 测量步态速度和 5 椅上升。111 名研究参与者中有 75% 是女性（平均年龄：82.5 (SD = 6.76) 岁。每日步行时间，在住院康复期间以及之后，随着整体 PA 方面的增加，直立时间和步数增加。深入的 PA 参数显示出不同的模式。虽然步行总次数类似地增加，但出院后较长时间步行的次数减少了 50%。这种模式也出现在平均步行间隔长度上，在住院康复期间增加了 2.34 秒（95% 置信区间 (CI)：0.68；4.00），之后下降到基线水平以下（- 4.19 秒（95% CI：- 5.56） ; − 2.82))。传统的 PC 测量显示出与深度 PA 参数相似的模式，但在康复期间有所改善，但在家中则不然。我们的研究结果表明，深入的 PA 参数为全局累积 PA 参数添加了更多信息。尽管在住院康复期间和出院后总体累积 PA 参数显着改善，但在家中的深度 PA 参数和 PC 并未持续改善。与全局累积 PA 参数相比，深度参数似乎反映了上下文因素，例如构建环境和 PC 方面，传统上通过临床 PC 测量来评估这些因素。这些与数字移动性措施相结合，可以帮助临床医生评估脆性骨折患者的健康状况，个性化定制治疗措施并监控康复过程。与全局累积 PA 参数相比，深度参数似乎反映了上下文因素，例如构建环境和 PC 方面，传统上通过临床 PC 测量来评估这些因素。这些与数字移动性措施相结合，可以帮助临床医生评估脆性骨折患者的健康状况，个性化定制治疗措施并监控康复过程。与全局累积 PA 参数相比，深度参数似乎反映了上下文因素，例如构建环境和 PC 方面，传统上通过临床 PC 测量来评估这些因素。这些与数字移动性措施相结合，可以帮助临床医生评估脆性骨折患者的健康状况，个性化定制治疗措施并监控康复过程。