Prevalence and progression of limb contractures amongst long-term care residents: Data from a 5-year observational study

Background: Limb contractures are associated with poor outcomes and quality of life in long-term care facility (LTCF) residents. We aimed to study the prevalence and progression of limb contractures over a 5-year follow-up period amongst LTCF residents in Hong Kong. Method(s): From the Hong Kong Longitudinal Study on LTCF Residents between 2005 and 2015, we analyzed the data for residents who had assessment from the 1st up to 5th year since admission. Trained nurses, social workers and therapists utilized the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) in 10 residential LTCFs. Limb contractures were defined as functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes were annual prevalence and time trend of limb contractures over 5 years. Result(s): We analyzed the data for 1,736 older residents (611 men, mean age 83.2 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 30% to 36%, and lower limb contractures increased from 41% to 56%. Time trends were as follows: the proportion of residents who had no contractures on admission remained contracture-free after 5 years was 59.7% for upper limbs and 39.8% for lower limbs, while the proportion of residents who had developed new contractures after 5 years was 15.1% for upper limbs and 26.5% for lower limbs. The proportion of residents who had unilateral contractures on admission which had improved after 5 years was 4.1% for both upper limbs and lower limbs, and the proportion of residents who had either unilateral or bilateral contractures on admission which did not change after 5 years was 21.2% in upper limbs and 29.6% in lower limbs. Conclusion(s): Joint contractures are highly prevalent amongst residents admitted to the LTCF, and many residents develop new or worse contractures during the first 5 years of their admission. Further studies are needed to identify the potential strategies to prevent functional decline in this vulnerable group.

AM