Self-perceived functioning and (instrumental) activities of daily living questionnaires after a hip fracture: Do they tell the same story?

Background: (Instrumental) activities of daily living ((I)ADL) questionnaires are often used as a measure of functioning for different purposes. Depending on the purpose, a measurement of functioning that includes subjective patient perspectives can be relevant. However, it is unclear to what extent (I)ADL instruments capture self-perceived functioning.

Objective: Explore what functioning means to older persons after a hip fracture and assess the extent to which (I)ADL instruments align with self-perceived functioning.

Design: Qualitative interview study with framework analysis.

Setting: Prospective cohort study on recovery after a hip fracture among older persons in a hospital in a large city in the west of the Netherlands.

Subjects: Eighteen home-dwelling older persons (≥70 years) who had a hip fracture 6-12 months ago.

Methods: Telephone interviews about functioning before and after the hip fracture were coded and analysed using the framework method.

Results: The activities mentioned by participants to be part of their self-perceived functioning could be split into activities necessary to maintain the desired level of independence, and more personal activities that were of value to participants. Both the 'independence activities' and the 'valued activities' mentioned went beyond the activities included in (I)ADL questionnaires. Due to various coping strategies, limitations in activities that are measured in the (I)ADL questionnaires did not necessarily lead to worse self-perceived functioning.

Conclusion: Self-perceived functioning differs from functioning measured with (I)ADL questionnaires in the items included and the weighing of limitations in activities. Thus, (I)ADL instruments alone are not enough to measure functioning from the perspective of the older person.