Archives of Physical Medicine and Rehabilitation
Volume 91, Issue 1 , Pages 51-57, January 2010

Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

Presented to the Swedish Orthopaedic Association, September 3, 2008, Halmstad, Sweden.

  • Amer N. Al-Ani, MD

      Affiliations

    • Institute of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopaedics, Karolinska University Hospital, Huddinge, Sweden
    • Corresponding Author InformationReprint requests to Amer N. Al-Ani, MD, Dept of Orthopaedics, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden
    • ,
  • Lena Flodin, MD

      Affiliations

    • Institute of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Department of Geriatric Medicine, Sweden
    • ,
  • Anita Söderqvist, RN, PhD

      Affiliations

    • Karolinska Institutet, Department of Clinical Science and Education, section of Orthopedics Södersjukhuset, Sweden
    • ,
  • Paul Ackermann, MD, PhD

      Affiliations

    • Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Solna, Sweden
    • ,
  • Eva Samnegård, MD, PhD

      Affiliations

    • Karolinska Institutet, Department of Clinical Sciences, Section of Orthopaedics, Danderyd Hospital, Sweden
    • ,
  • Nils Dalén, MD, PhD

      Affiliations

    • Karolinska Institutet, Department of Clinical Sciences, Section of Orthopaedics, Danderyd Hospital, Sweden
    • ,
  • Maria Sääf, MD, PhD

      Affiliations

    • Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
    • ,
  • Tommy Cederholm, MD, PhD

      Affiliations

    • Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Sweden
    • ,
  • Margareta Hedström, MD, PhD

      Affiliations

    • Institute of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopaedics, Karolinska University Hospital, Huddinge, Sweden

Abstract 

Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.

Objective

To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.

Design

Population-based cohort study.

Setting

A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.

Participants

Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0–2 points] score) in Short Portable Mental Status Questionnaire [0–10 points]) and able to walk before the fracture.

Interventions

Not applicable.

Main Outcome Measure

Walking ability and ADLs index at 4-month and 12-month follow-up.

Results

Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1–7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52–22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44–19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8–3.5; P<.001), while type of surgery was not (P=.376).

Conclusions

Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.

Key Words: Activities of daily living, Dementia, Hip fractures, Rehabilitation, Walking

List of Abbreviations: ADLs, activities of daily living, ASA, American Society of Anesthesiologists, CI, confidence interval, HA, hemiarthroplasty, MMSE, Mini-Mental State Examination, OR, odds ratio, SPMSQ, Short Portable Mental Status Questionnaire

 

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(09)00758-8

doi:10.1016/j.apmr.2009.09.005

Archives of Physical Medicine and Rehabilitation
Volume 91, Issue 1 , Pages 51-57, January 2010

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