Inpatient Rehabilitation Outcome After Hip Fracture Surgery in Elderly Patients: A Prospective Cohort Study of 946 Patients
Abstract
Lieberman D, Friger M, Lieberman D. Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients.
Objective
To identify the factors associated with inpatient rehabilitation outcome after surgical repair of hip fracture in elderly patients.
Design
A noninterventional prospective cohort study.
Setting
Geriatric inpatient rehabilitation center in a tertiary university medical center in southern Israel.
Participants
Patients (N=946) aged 65 years of age or older who were hospitalized for rehabilitation after surgery for hip fracture.
Interventions
Not applicable.
Main Outcome Measures
Functional studies by the FIM instrument and a broad spectrum of clinical, demographic, and social variables. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the percentage change in the FIM score during the course of rehabilitation in relation to the severity of the functional impairment at its inception.
Results
Eight variables were significantly and independently associated with rehabilitation outcome. Prefracture FIM scale (standardized regression coefficient in multiple regression [β]=.261, P<.001), serum albumin at discharge (β=.222, P<.001), Folstein Mini-Mental State Examination (β=.174, P<.001), visual impairment (β=−.089, P=.002), dyspnea at mild exertion (New York Heart Association class III) (β=−.080, P=.005), age (β=−.080, P=.007), poststroke motor impairment (β=−.072, P=.011), and decreased serum folic acid (β=−.055, P=.047). The total percentage of the explained variance of the primary rehabilitation outcome measure accounted for by these 8 variables (adjusted R2) was 31.9%.
Conclusions
The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 clinical and nutritional correctable parameters. The other 4 variables that are associated with the process cannot be corrected but may help predict outcomes and adjust expectations.
aDepartment of Geriatrics, Soroka University Medical Center, Klalit Health Services, Beer-Sheva, Israel
bDivision of Internal Medicine, Soroka University Medical Center, Klalit Health Services, Beer-Sheva, Israel
cDepartment of Epidemiology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
dFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Reprint requests to Devora Lieberman, MD, Dept of Geriatrics, Soroka Medical Center, POB 151, Beer-Sheva 84101, Israel
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT