Patient Participation and Physical Activity During Rehabilitation and Future Functional Outcomes in Patients After Hip Fracture
Presented to the American Physical Therapy Association in San Diego, CA, February 1-5, 2006, and to the American Geriatric Society, Seattle, WA, May 2-6, 2007.
Abstract
Talkowski JB, Lenze EJ, Munin MC, Harrison C, Brach JS. Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture.
Objective
To examine the association between physical activity recorded by actigraphy during therapy sessions (therapy) with therapist-rated patient participation and self-reported future functional outcomes. We hypothesized those participants who were more active during rehabilitation would have higher participation scores and better functional outcomes after hip fracture compared with those who were less active.
Design
Longitudinal study with a 3- and 6-month follow-up.
Setting
Participants were recruited from skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs).
Participants
Participants included 18 community-dwelling older adults admitted to SNFs or IRFs facilities after hip fracture. Participants were included if they were 60 years of age or older and ambulatory with or without assistance from a device or another person.
Interventions
Not applicable.
Main Outcome Measures
Physical activity was quantified during participants' rehabiliation by using the actigraph accelerometer worn consecutively over 5 days. The Pittsburgh Participation Rating Scale was used to quantify patient participation during their inpatient therapy sessions. Self-reported functional outcomes were measured by the Hip Fracture Functional Recovery Scale at baseline and 3 and 6 months after fracture.
Results
Participants with higher actigraphy counts during rehabilitation were ranked by their therapists as having excellent participation compared with those who were less active. Participants who were more active reported better functional abilities at both the 3- and 6-month time points and achieved 78% and 91% recovery of self-reported prefracture function compared with those who were less active achieving 64% and 73% recovery.
Conclusions
Actigraphy provides an objective measure of physical activity exhibiting predictive validity for future functional outcomes and concurrent validity against patient participation in patients after hip fracture.
aDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
bDepartment of Psychiatry, Washington University School of Medicine, St. Louis, MO
cDepartment of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
dUniversity of Pittsburgh Medical Center Institute for Rehabilitation and Research Montefiore Hospital, Centers for Rehab Services, Pittsburgh, PA
Reprint requests to Jaime B. Talkowski, PhD, MPT, Dept of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260
Supported by the Pittsburgh Claude D. Pepper Older Americans Independence Center (grant no. P30 AG024827), the Promotion of Doctoral Studies Award I and II American Physical Therapy Association, and the University of Pittsburgh Hip Fracture Study (grant no. R21 HD043202-01 NIH/NICHHD).
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors.
ABSTRACT