A path analysis model of mobility among persons with hip fracture after surgery

Abstract

This correlational study aimed to 1) investigate mobility and 2) examine direct and indirect paths of relationships among comorbidity, cognitive function, social support, pain, fatigue, and sleep quality on mobility among persons with hip fracture after surgery. The hypothesized model was constructed based on the theory of unpleasant symptoms and the literature reviewed. A three-stage random sampling approach was utilized to recruit 260 persons with hip fracture after surgery aged 50 years old and older who visited four hospitals in three health regions of Thailand. Research measurements consisted of the demographic data form, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pittsburgh Sleep Quality Index, Numerical rating scale, and de Morton Mobility Index. Data were collected from July 2022 to February 2023. The data analysis using SPSS and Mplus program

The study findings revealed that 1) the average mean of mobility was 47.51 (SD 15.63) and 2) the hypothesized model fit the empirical and could explain 90.4 % of the variance of the mobility (Chi-square= 415.198, df= 372, p=0.0605, Chi-square/df= 1.116, RMSEA= 0.021, CFI= .993, TLI= .991, SRMR= .036). Sleep quality was the most the influential factor affecting mobility by having both negative direct and indirect effect on mobility through fatigue (β = -1.385, p < .001). Cognitive function had a positive direct and indirect effect on mobility through sleep (β = .792, p < .001). Fatigue only had a negative direct effect on mobility (β = -.674, p < .001). Pain only had a negative direct effect on mobility (β = -.182, p < .05). Comorbidity had a positive indirect effect on mobility through pain (β = .164, p < .05). However, social support had a non-significant direct effect on mobility (β = .109, p > .05).

The findings indicated that comorbidity, cognitive function, fatigue, sleep quality, and pain were important factors influencing mobility among persons with hip fracture after surgery. Therefore, future nursing interventions should enhance cognitive function, and sleep quality. Managing comorbidity, fatigue, and pain to maintain or enhance mobility among persons with hip fracture after surgery.