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dc.contributor.authorJohnson, Rasheeda J.
dc.date.accessioned2016-06-28T13:02:17Z
dc.date.available2017-02-06T17:03:37Z
dc.date.issued2016
dc.identifier.urihttp://hdl.handle.net/10713/5462
dc.descriptionUniversity of Maryland, Baltimore. Epidemiology and Preventive Medicine. Ph.D. 2016en_US
dc.description.abstractBackground: Limb length discrepancy (LLD), a common complication following hip fracture, is present when paired lower extremities are of unequal lengths. LLD consequences include chronic low-back pain, standing imbalance, nerve palsy and gait abnormalities. There is a paucity of LLD studies in older adults and no study to date has investigated LLD in hip fracture patients, a large population of older adults experiencing late life disability and decline in functional mobility. Objectives: Specific aims of this study were to: (1) Determine the reproducibility, validity and repeatability of Dual Energy X-ray Absorptiometry-Linear Pixel Count (DXA-LPC) method to measure limb length and assess for LLD in hip fracture patients, using mixed effects regression modeling; (2) Determine the prevalence and changes in LLD over the 12-months post fracture using general linear modeling; and (3) Determine the association between LLD severity and functional and health-related outcomes during 12-months post fracture using general linear modeling. Methods: Data come from the Baltimore Hip Studies 4th cohort (BHS-4; 1998-2004), a study of 180 community-dwelling women age 65+ with incident hip fractures enrolled in a RCT of an in-home exercise intervention. Three expert assessors and study PI measured limb lengths from whole-body DXA images electronically stored from BHS-4 at baseline and 2, 6, and 12 months post-fracture. Functional and health-related outcomes included the Lower Extremity Gain Scale (LEGS), Yale Physical Activity Scale (YPAS), mobility score, number of falls, and hip and general pain and assessed at each follow-up time-point. Results: Reproducibility of DXA-LPC was moderate, while validity and repeatability were both excellent. Majority (~75%) of participants experienced LLD; findings were consistent across all study time-points. Mean absolute LLD did not statistically change over time (mean=14.7mm). Adjusted results indicate a significant adverse relationship between LLD severity and number of falls (p=0.006) with nonsignificant adverse relationships with other functional outcomes. Conclusions: LLD severity contributes significantly to falls during the year following a hip fracture. Findings also indicate clinically meaningful differences in functional outcomes between LLD groups. Interventional studies should investigate shoe lift therapy efficacy and other post-operative mechanisms to minimize the impact of LLD on post-fracture functional recovery.en_US
dc.language.isoen_USen_US
dc.subjectBaltimore Hip Studiesen_US
dc.subjectdual-energy X-ray absorptiometryen_US
dc.subjectfallsen_US
dc.subjectfunctional mobilityen_US
dc.subjectlimb length discrepancyen_US
dc.subject.lcshWomenen_US
dc.subject.meshAbsorptiometry, Photonen_US
dc.subject.meshAccidental Fallsen_US
dc.subject.meshAgeden_US
dc.subject.meshHip Fractures--complicationsen_US
dc.titleEffects of Limb Length Discrepancy on Functional and Health-Related Outcomes in Hip Fracture Patientsen_US
dc.typedissertationen_US
dc.contributor.advisorOrwig, Denise L.
dc.contributor.orcid0000-0002-8397-9909
refterms.dateFOA2019-02-21T02:10:26Z


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