Hip Fracture Rehab
Latham, N., Jette, D., Warren, R. and Wirtalla, C. (2006) Pattern of functional change during rehabilitation of patients with hip fracture. Archives of Physical Medicine and Rehabilitation; 87: 111-116
Objective: To examine the rate of functional change in ADL and mobility over 2 time periods during skilled rehabilitation.
Design: 351 hip fracture patients in 70 SNFs with discharges form 3/98 to 2/03 were evaluated by measuring the change in FIM domain score from admission to the first interim assessment and then again from the first interim measurement to a second or the discharge assessment. Rate of change in FIM score/day was used as the primary outcome measure.
Results: For mobility, rate of change per day was constant across the two time periods (approximately 6 days each): .46 and .49 points/day. However, for patients with lower baseline mobility, rate of change was greater in the second period. For ADL domain, rate of change was lower in the second period compared to the first: .55 vs .41 points/day. Higher executive function and lower medical complexity were associated with greater overall change.
Conclusions: Patterns of recovery differ depending on modality measured and are affected by admission score, executive function and medical complexity.
Relevance: This is the first study to examine the rate of change in rehabilitation using interval assessment. The fact that recovery is not linear for mobility and ADL suggests that therapy intensity, therapy goal setting and discharge planning should take such factors into consideration.
