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Characteristics and Outcomes of Patients in Rehabilitation with Hip Fracture: A Retrospective Chart Review

Published online by Cambridge University Press:  09 July 2018

Erica Anders*
Affiliation:
Department of Physical Therapy, University of Toronto
Wendy Laskey
Affiliation:
Department of Physical Therapy, University of Toronto
Catherine Milne-Gibson
Affiliation:
Department of Physical Therapy, University of Toronto
Brendan Pynenburg
Affiliation:
Department of Physical Therapy, University of Toronto
Chelsea Wong
Affiliation:
Department of Physical Therapy, University of Toronto
Anna Berall
Affiliation:
Baycrest Health Sciences, Toronto
Nancy Jones
Affiliation:
Lakeridge Health Oshawa
Debbie Mendelson
Affiliation:
Baycrest Health Sciences, Toronto
Susan Jaglal
Affiliation:
Department of Physical Therapy, University of Toronto
*
La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Erica Anders, MScPT Department of Physical Therapy University of Toronto 160-500 University Ave Toronto ON M5G 1V7 <[email protected]>

Abstract

Hip fracture rehabilitation has two streams: high tolerance short duration (HTSD) and low tolerance long duration (LTLD). This study examined patient characteristics and outcomes in HTSD and LTLD associated with length of stay (LOS) and discharge destination. We retrospectively examined patients’ medical charts following hip fracture surgery and collected demographic, functional, and health characteristics. A statistical analysis was done to describe the differences between HTSD (n = 73) and LTLD (n = 57) patient characteristics and their relationship with LOS and discharge destination. Those in LTLD were significantly older, less independent with prefracture bathing and instrumental activities of daily living, had lower Functional Independence Measure (FIM) admission scores, and more co-morbidities. Higher FIM motor score on admission in HTSD and greater change in FIM total score in LTLD was significantly correlated with discharge home. Diabetes in LTLD and lower total admission FIM in HTSD was significantly associated with increased LOS.

Résumé

Deux voies de réadaptation sont utilisées dans les cas de fractures de la hanche : la voie de courte durée avec tolérance élevée (CDTÉ) et celle de longue durée avec basse tolérance (LDBT). Cette étude a examiné les caractéristiques et les résultats de patients en CDTÉ et LDBT qui étaient associés avec la durée du séjour à l’hôpital (DSH) et la destination après le congé de l’hôpital (DC). Un examen rétrospectif des dossiers médicaux des patients opérés pour une fracture de la hanche a été réalisé après leur chirurgie. Les données démographiques, fonctionnelles et liées à la santé de ces patients ont été collectées. Des analyses statistiques ont été effectuées afin d’évaluer les différences entre les caractéristiques des patients en CDTÉ (n = 73) et en LDBT (n = 57), et leurs liens avec leur DSH et DC. Les patients en LDBT étaient plus âgés et leur niveau d’autonomie pré-fracture pour le bain et les activités instrumentales de la vie quotidienne était plus faible. Les résultats de ces patients pour la Mesure de l’indépendance fonctionnelle (MIF) à l’admission étaient aussi plus faibles, et leur taux de comorbidités, plus élevé. Des scores MIF plus élevés à l’admission pour les patients en CDTÉ et une évolution plus marquée des scores MIF pour les patients LDBT étaient associés à la destination « maison » après le congé de l’hôpital. Le taux de diabète chez les patients en LDBT et un score MIF plus faible étaient liés à une DSH plus longue.

Type
Article
Copyright
Copyright © Canadian Association on Gerontology 2018 

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Footnotes

*

The authors acknowledge Jurgis Karuza for his assistance in this research. This research was completed in partial fulfillment of the requirements for an MScPT degree at the University of Toronto.

References

Arinzon, Z., Fidelman, Z., Zuta, A., Peisakh, A., & Berner, Y. N. (2005). Functional recovery after hip fracture in old-old elderly patients. Archives of Gerontology and Geriatrics, 40(3), 327336. doi: S0167-4943(04)00174-8CrossRefGoogle ScholarPubMed
Ariza-Vega, P., Kristensen, M. T., Martin-Martin, L., & Jimenez-Moleon, J. J. (2015). Predictors of long-term mortality in older people with hip fracture. Archives of Physical Medicine and Rehabilitation, 96(7), 12151221. doi: 10.1016/j.apmr.2015.01.023CrossRefGoogle ScholarPubMed
Beaupre, L. (2011). Functional recovery of hip fracture patients. Retrieved from http://boneandjointcanada.com/wp-content/uploads/2014/05/Functional-Recovery_Final.pdfGoogle Scholar
Beaupre, L. A., Binder, E. F., Cameron, I. D., Jones, C. A., Orwig, D., Sherrington, C., & Magaziner, J. (2013). Maximising functional recovery following hip fracture in frail seniors. Best Practice & Research. Clinical Rheumatology, 27(6), 771788. doi: 10.1016/j.berh.2014.01.001CrossRefGoogle ScholarPubMed
Blackman-Weinberg, C., Crook, J., Roberts, J., & Weir, R. (2005). Longitudinal study of inpatients admitted to a general activation service: Variables that predict discharge to a patient’s discharge goal location. Archives of Physical Medicine and Rehabilitation, 86(9), 17821787. doi: S0003-9993(05)00414-4CrossRefGoogle ScholarPubMed
Canadian Institute for Health Information. (2015). Factors predicting return home from inpatient rehabilitation following hip fracture surgery. Ottawa, ON: Author. Retrieved from https://secure.cihi.ca/free_products/NRS_Hips_2015_EN_web.pdfGoogle Scholar
Castelli, A., Daidone, S., Jacobs, R., Kasteridis, P., & Street, A. D. (2015). The determinants of costs and length of stay for hip fracture patients. PloS One, 10(7), e0133545. doi: 10.1371/journal.pone.0133545CrossRefGoogle ScholarPubMed
Cheng, C. L., Lau, S., Hui, P. W., Chow, S. P., Pun, W. K., Ng, J., & Leong, J. C. (1989). Prognostic factors and progress for ambulation in elderly patients after hip fracture. American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists, 68(5), 230233. Retrieved from https://journals.lww.com/ajpmr/pages/articleviewer.aspx?year=1989&issue=10000&article=00006&type=abstractCrossRefGoogle ScholarPubMed
Gialanella, B., Ferlucci, C., Monguzzi, V., & Prometti, P. (2015). Determinants of outcome in hip fracture: Role of daily living activities. European Journal of Physical and Rehabilitation Medicine, 51(3), 253260. Retrieved from https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2015N03A0253Google ScholarPubMed
GTA Rehab Network. (2009). Inpatient rehab/LTLD referral guidelines. Retrieved from http://www.gtarehabnetwork.ca/uploads/File/tools/inpatient-rehab-LTLD-referral-guidelines.pdfGoogle Scholar
Health Quality Ontario and Ministry of Health and Long-Term Care. (2016). Quality-based procedures: Clinical handbook for stroke (acute and postacute). Toronto, ON: Author. Retrieved from http://health.gov.on.ca/en/pro/programs/ecfa/docs/qbp_stroke.pdfGoogle Scholar
Health Quality Ontario & Ministry of Health and Long-Term Care. (2013). Quality-based procedures: Clinical handbook for hip fractures. Toronto, ON: Author. Retrieved from http://health.gov.on.ca/en/pro/programs/ecfa/docs/qbp_hipfracture.pdfGoogle Scholar
Hershkovitz, A., Beloosesky, Y., & Brill, S. (2012). Mobility assessment of hip fracture patients during a post-acute rehabilitation program. Archives of Gerontology and Geriatrics, 55(1), 3541. doi: 10.1016/j.archger.2011.06.036CrossRefGoogle ScholarPubMed
Hershkovitz, A., Kalandariov, Z., Hermush, V., Weiss, R., & Brill, S. (2007). Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Archives of Physical Medicine and Rehabilitation, 88(7), 916921. doi: S0003-9993(07)00257-2CrossRefGoogle ScholarPubMed
Heruti, R. J., Lusky, A., Barell, V., Ohry, A., & Adunsky, A. (1999). Cognitive status at admission: Does it affect the rehabilitation outcome of elderly patients with hip fracture? Archives of Physical Medicine and Rehabilitation, 80(4), 432436. doi: S0003-9993(99)90281-2CrossRefGoogle ScholarPubMed
Howell, D. C. (1998). Statistical methods in human sciences. New York, NY: Wadsworth.Google Scholar
Hulsbaek, S., Larsen, R. F., & Troelsen, A. (2015). Predictors of not regaining basic mobility after hip fracture surgery. Disability and Rehabilitation, 37(19), 17391744. doi: 10.3109/09638288.2014.974836CrossRefGoogle Scholar
Huusko, T. M., Karppi, P., Avikainen, V., Kautiainen, H., & Sulkava, R. (2000). Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: Subgroup analysis of patients with dementia. BMJ (Clinical Research Ed.) , 321(7269), 11071111. doi: http://dx.doi.org/10.1136/bmj.321.7269.1107CrossRefGoogle ScholarPubMed
Kristensen, M. T. (2013). Hip fracture-related pain strongly influences functional performance of patients with an intertrochanteric fracture upon discharge from the hospital. PM & R: The Journal of Injury, Function, and Rehabilitation, 5(2), 135141. doi: 10.1016/j.pmrj.2012.10.006CrossRefGoogle ScholarPubMed
Kristensen, M. T., Foss, N. B., & Kehlet, H. (2009). Factors with independent influence on the ‘timed up and go’ test in patients with hip fracture. Physiotherapy Research International: The Journal for Researchers and Clinicians in Physical Therapy, 14(1), 3041. doi: 10.1002/pri.414CrossRefGoogle ScholarPubMed
Landi, F., Bernabei, R., Russo, A., Zuccala, G., Onder, G., Carosella, L., ... Cocchi, A. (2002). Predictors of rehabilitation outcomes in frail patients treated in a geriatric hospital. Journal of the American Geriatrics Society, 50(4), 679684. https://www.ncbi.nlm.nih.gov/pubmed/11982668CrossRefGoogle Scholar
Lee, D., Jo, J. Y., Jung, J. S., & Kim, S. J. (2014). Prognostic factors predicting early recovery of pre-fracture functional mobility in elderly patients with hip fracture. Annals of Rehabilitation Medicine, 38(6), 827835. doi: 10.5535/arm.2014.38.6.827CrossRefGoogle ScholarPubMed
Leung, G., Katz, P. R., Karuza, J., Arling, G. W., Chan, A., Berall, A., … Naglie, G. (2016). Slow stream rehabilitation: A new model of post-acute care. Journal of the American Medical Directors Association, 17(3), 238243. doi: 10.1016/j.jamda.2015.10.016CrossRefGoogle ScholarPubMed
Lieberman, D., Fried, V., Castel, H., Weitzmann, S., Lowenthal, M. N., & Galinsky, D. (1996). Factors related to successful rehabilitation after hip fracture: A case-control study. Disability and Rehabilitation, 18(5), 224230. doi: 10.3109/09638289609166305CrossRefGoogle ScholarPubMed
Marcantonio, E. R., Flacker, J. M., Michaels, M., & Resnick, N. M. (2000). Delirium is independently associated with poor functional recovery after hip fracture. Journal of the American Geriatrics Society, 48(6), 618624. doi: 10.1111/j.1532-5415.2000.tb04718.xCrossRefGoogle ScholarPubMed
Morghen, S., Bellelli, G., Manuele, S., Guerini, F., Frisoni, G. B., & Trabucchi, M. (2011). Moderate to severe depressive symptoms and rehabilitation outcome in older adults with hip fracture. International Journal of Geriatric Psychiatry, 26(11), 11361143. doi: 10.1002/gps.2651Google ScholarPubMed
O’Neill, T. J., McCarthy, K., & Newton, B. M. (1987). Slow-stream rehabilitation: Is it effective? The Medical Journal of Australia, 147(4), 172175. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3657628Google ScholarPubMed
Papadimitropoulos, E. A., Coyte, P. C., Josse, R. G., & Greenwood, C. E. (1997). Current and projected rates of hip fracture in Canada. CMAJ: Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne, 157(10), 13571363. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1228461/Google Scholar
Rehabilitative Care Alliance. (2015). Planning considerations for reclassification (PCRC) of Rehab/CCC beds: PCRC toolkit. Retrieved from http://rehabcarealliance.ca/uploads/File/Toolbox/PCRC/PCRC_Toolkit_FINAL_REVISED_January_2015.pdfGoogle Scholar
Semel, J., Gray, J. M., Ahn, H. J., Nasr, H., & Chen, J. J. (2010). Predictors of outcome following hip fracture rehabilitation. PM & R: The Journal of Injury, Function, and Rehabilitation, 2(9), 799805. doi: 10.1016/j.pmrj.2010.04.019CrossRefGoogle ScholarPubMed
Toronto Central Local Health Integration Network. (2015). Resource matching & referral – About. Retrieved from https://resourcematchingandreferral.com/about/Google Scholar
Uniform Data System for Medical Rehabilitation. (2016). About the FIM system. Amherst, NY: Author. Retrieved from http://www.udsmr.org/WebModules/FIM/Fim_About.aspxGoogle Scholar
Wang, C. Y., Graham, J. E., Karmarkar, A. M., Reistetter, T. A., Protas, E. J., & Ottenbacher, K. J. (2014). FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture. PM & R: The Journal of Injury, Function, and Rehabilitation, 6(6), 493497. doi: 10.1016/j.pmrj.2013.12.008CrossRefGoogle ScholarPubMed