Association between patient-reported outcomes and accelerometer-based activity in elderly patients 12 months after proximal humerus fracture: Results from two randomized controlled trials

Aims: Patient-reported outcome measures (PROMs) represent outcomes important to patients and are subjective rather than objective measures like mortality or reoperations. Their use has, however, limitations. We aimed to investigate the association between PROMS and accelerometer-based movement in older adults with proximal humerus fractures. Methods: This is a secondary analysis of two previously conducted randomized controlled trials. The first trial included patients aged 60 years or more with any proximal humerus fracture allocated to nonoperative treatment or operative treatment. The second trial included patients aged 60 years or more with a 2-part fracture allocated to different physiotherapy regimes. A subgroup of patients in these trials wore tri-axial accelerometers in both their upper extremities for 4 days at the 1-year follow-up. Functional outcome was measured with Disability of Arm, Shoulder and Hand (DASH), Constant score, and 15D quality of life questionnaire. Ordinary least squares regression was used to estimate the association between PROMs and accelerometer-based activity. Results: The final study cohort included 100 patients with a mean age of 73 years. Patients were predominantly females (86%) with a 2-part fracture (65%). All activity level categories (inactivity, light, moderate) had a weak association with DASH when adjusted for baseline variables. Based on the confidence intervals, none of the regression coefficients have statistical significance for the association. Similar findings were seen for 15D quality-of-life measurements. Conclusions: Our results show that, in older adults, commonly used PROMs have a negligible and uncertain association with objectively measured upper extremity activity 1 year after a proximal humerus fracture.