Intensive In-hospital Rehabilitation After Hip Fracture Surgery and Activities of Daily Living in Patients With Dementia: Retrospective Analysis of a Nationwide Inpatient Database

We read the article by Uda et al entitled “Intensive In-hospital Rehabilitation After Hip Fracture Surgery and Activities of Daily Living in Patients With Dementia: Retrospective Analysis of a Nationwide Inpatient Database.” The authors analyzed a large sample size (n=43,206) of the nationwide inpatient administrative claims and discharge database in Japan and examined whether earlier, more frequent, and larger daily amounts of postoperative rehabilitation on activities of daily living (ADL), measured by the 100-point Barthel Index (BI) scale, were effective for patients with dementia who underwent hip fracture surgery. The authors concluded earlier, more frequent, and larger daily amounts of rehabilitation were associated with better recovery in the BI scores. We believe the study is meaningful in terms of conducting new rehabilitation strategy for patients with dementia after hip fractures and agree the intensive rehabilitation is somewhat effective for recovery in ADL. On the other hand, we have concerns regarding the effect sizes of early and intensive interventions in their study; the effect sizes were only −0.38 for early rehabilitation and 4.37-6.60 for large amounts of rehabilitation, which we believe are not clinically significant. Here, we discuss the interpretation of the findings from Uda’s article in respect to clinical and statistical significance.