Impact of place of residence, frailty and other factors on rehabilitation outcomes post hip fracture

2020 ◽  
Author(s):  
Stephanie Low ◽  
Edmund Wee ◽  
Michael Dorevitch
Keyword(s):  
Hip Fracture ◽  
Residential Care ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Community Dwelling ◽  
Hip Fracture Surgery ◽  
Rehabilitation Outcomes ◽  
Poor Outcomes ◽  
Fracture Surgery

Abstract Background Following hip fracture surgery, patients from residential care are frequently excluded from inpatient rehabilitation. We aimed to assess the impact of place of residence and other factors such as frailty on rehabilitation outcomes after hip fracture surgery. Methods Retrospective cohort study. Outcome measures included Functional Independence Measure efficiency, discharge destination and recovery of pre-fracture mobility. Univariable and multivariable linear or logistic regression analyses were performed. Setting One general rehabilitation and two geriatric evaluation and management wards in a large public tertiary teaching hospital. Participants A total of 844 patients who underwent inpatient rehabilitation after hip fracture surgery from 2010 to 2018. Results There were 139 (16%) patients from residential care. Being from residential care was not an independent predictor of poor outcomes. Premorbid frailty (Clinical Frailty Scale) was the strongest independent predictor of poorer Functional Independence Measure efficiency, inability to recover pre-fracture mobility and return to community dwelling. Dementia and delirium were also independently predictive of poor outcomes across all measures. Age > 90 years was independently predictive of inability to recover pre-fracture mobility and return to community dwelling. Conclusion Being from residential care is not independently associated with poor outcomes following inpatient rehabilitation after hip fracture surgery and should not be the basis for excluding these patients from rehabilitation. Major predictors of poorer outcomes include premorbid frailty, dementia, delirium and age > 90 years. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life.

scholarly journals INFLUENCE OF HEALTH AND SOCIAL SUPPORTS ON OUTCOMES POST-REHABILITATION FOR HIP FRACTURE SURGERY: SYSTEMATIC REVIEW

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S737-S737
Author(s):  
Katherine McGilton ◽  
Shirin Vellani ◽  
Melanie Bayly ◽  
Elizabeth Tanjong-Ghogomu ◽  
Andrea Iaboni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Hip Fracture ◽  
Social Supports ◽  
Inpatient Rehabilitation ◽  
Interdisciplinary Teams ◽  
Community Dwelling ◽  
Post Discharge ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Background: Older adults who sustain hip fractures encounter physical and functional decline after discharge from inpatient rehabilitation. Currently, a synthesis of literature is lacking on health and social supports that may impact outcomes in the community-dwelling older adults, post-discharge from rehabilitation. Methodology: We conducted a systematic review to a) evaluate how health and social supports influence outcomes for older adults and their caregivers following inpatient rehabilitation post-hip fracture surgery, and b) identify the factors that affect their impact on outcomes. We searched Medline, CINAHL, Embase, Emcare, Psychinfo, and Ageline for publications between 2000 and 2018. We followed Cochrane Handbook methods to screen titles and abstracts, appraise quality, collect data and synthesize results. Results: A total of 3364 articles were retrieved, and 34 studies were included for final synthesis, including 24 randomized control trials and 10 observational studies. Most studies excluded persons with moderate or severe cognitive impairment. Interventions can be broadly categorized as either comprehensive care delivered by interdisciplinary teams focusing on exercise, nutrition and fracture prevention; or exercise sessions delivered by health professionals, trained instructors or volunteers. Interventions involving interdisciplinary teams demonstrated moderate improvement of mobility and functional ability in the first 3 months. However, the longitudinal effects of interventions were not realized for all. Conclusion: This review provides evidence of the effectiveness of health and social supports provided to older adults post-hip fracture. We are uncertain of the applicability to people with cognitive decline due to exclusion from most studies. Implications for practice and research will be discussed.

scholarly journals Rehabilitation for cerebral palsy: Analysis of the Australian rehabilitation outcome dataset

2011 ◽  
Vol 02 (01) ◽  
pp. 043-049
Author(s):  
Bhasker Amatya ◽  
Fary Khan
Keyword(s):  
Cerebral Palsy ◽  
Information Needs ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Hospital Length Of Stay ◽  
Functional Improvement ◽  
Specific Information ◽  
Hospital System ◽  
Rehabilitation Outcomes

ABSTRACT Objective: To examine the outcome of inpatient rehabilitation for cerebral palsy (CP), using the Australian Rehabilitation Outcomes Center (AROC) database. Materials and Methods: De-identified data from the AROC database was analyzed for all rehabilitation admissions during 2003 – 2008, using four classes for the functional level. The outcomes included: Functional Independence Measure (FIM) scores, FIM efficiency, hospital length of stay (LOS), and discharge destination. Results: Of 141 case episodes 56.7% were female, mean age 48.5 years, 87.2% were discharged to the community and 64.5% (n = 91) were in the lowest functional classes (217, 218, and 219). The majority of CP patients were treated in the public hospital system (66.7% versus 33.3%), and had a slightly longer LOS compared with those treated in private facilities (22.6 versus 17.9 days, mean difference - 4.7 days, 95% CI - 9.2 to - 0.2, P = 0.041). The FIM for all classes (216 – 218) showed significant functional improvement during the admission (P = 0.001). As expected those in the most functionally impaired classes showed most change (FIM change: 16.6 in class 217, 15.3 in class 218). FIM efficiency was the highest in classes 217 compared to the other classes. The year-to-year trend demonstrated a mixed pattern for hospital LOS and was not significant (P = 0.492). Conclusion: The AROC dataset is a valuable research tool for describing rehabilitation outcomes. However, more specific information needs to be collected alongside the core AROC data, to allow a more meaningful evaluation of outcomes for CP rehabilitation..

scholarly journals Inpatient Rehabilitation after Hip Fracture: Predicting Success in Rehabilitation based on Preliminary FIM

2021 ◽  
Vol 8 (1) ◽  
pp. 01-05
Author(s):  
Jochanan Naschitz
Keyword(s):  
Hip Fracture ◽  
Multidisciplinary Team ◽  
Comprehensive Evaluation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Center ◽  
Predicting Success ◽  
The Mean ◽  
Surrogate Measure

Background: Predicting success of inpatient rehabilitation after hip fracture is an unmet challenge Objective: To assess whether a first impression Functional Independence Measure (FIM) before comprehensive evaluation may be useful to predict success in rehabilitation Setting: Geriatric rehabilitation center. Design: Retrospective observational study Subjects: 42 consecutive elderly patients with proximal hip fracture. Methods: The Functional Independence Measure (FIM) was assessed on the day of admission by a nurse (PreFIM), on day 3-5 by a multidisciplinary team (FimAdm) and on the day before discharge by the same multidisciplinary team (FIMDis). The potential of motor PreFIM to predict rehabilitation success, corresponding to motor FIMDis >58, was assessed, along with the length of stay in rehabilitation (LOS). Results: The mean motor PreFIM was 43.3 (SD 11.4), motor FIMAdm 48.9 (SD 13.7), motor FIMDis 63.8 (SD 16.7), LOS 22.5 days (SD 9.7). Motor PreFIM predicted motor FIM discharge >58, the surrogate measure for success of rehabilitation, with 76.7% sensitivity and 83.3% specificity. Motor PreFIM relation to LOS was statistically insignificant. Conclusions: In a population of disabled elderlies, the motor PreFIM on admission-day was helpful to predict success in rehabilitation after hip fracture, but not the necessary duration of rehabilitation. Large prospective studies are needed to validate this data.

Abstract P200: Orthostatic Hypotension Is An Independent Predictor Of Delayed Rehabilitation Recovery

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Luis E Okamoto ◽  
Jin-Woo Park ◽  
Purnima Sharma ◽  
Andre Diedrich ◽  
Lauren Massey ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Electrolyte Imbalance ◽  
Factors Affecting ◽  
Rehabilitation Outcomes ◽  
Organ Systems ◽  
Negative Effect ◽  
Potential Factors

Inpatient acute rehabilitation is crucial in the management of patients after injuries, surgery, or those with debilitating or neurological conditions. Orthostatic hypotension (OH) is commonly associated with these conditions and can negatively impact their recovery. We found an incidence of OH of 4% in a cohort of 8350 patients at Vanderbilt Stallworth Rehabilitation Hospital (60±17yr, 72% men vs. non-OH 60±18 yr, 57% men). On admission, OH patients had a longer predicted length of rehabilitation hospitalization stay (LOS; 18±6 vs. non-OH 16±5 days; P<0.01) and lower Functional Independence Measure (FIM, 49±19 vs. non-OH 55±19; P<0.01), reflecting greater medical complexity. Actual LOS was even longer than predicted in OH (actual-predicted LOS [ΔLOS], 1±11 vs. non-OH -2±8 days; P<0.01) and FIM efficiency was lower ([discharge-admission FIM]/LOS, 2.5±1.6 vs. non-OH 3.1±1.9; P<0.01), suggesting that OH may be an independent factor for worse rehabilitation outcomes. To test this hypothesis, we conducted univariate and multivariate regression analyses in the adult patients (n=8146) of this cohort to include other potential factors affecting ΔLOS and FIM efficiency (age, sex, diagnosis of admission and comorbidities grouped into 22 categories by organ systems). We found that OH was independently associated with a longer than predicted LOS (i.e. greater ΔLOS) and lower FIM efficiency (regression coefficient 2.2±0.5 and -0.4±0.1, respectively; P<0.01). These associations remained significant after adjusting for predicted LOS and FIM on admission, suggesting that the effects of OH were not accounted for in these metrics. Other factors significantly associated with greater ΔLOS and lower FIM efficiency were comorbidities associated with the urinary tract, gastrointestinal and peripheral nervous systems, infections, electrolyte imbalance and pressure ulcers. In conclusion, OH has a major independent negative effect on rehabilitation outcomes, and is associated with longer than predicted inpatient rehabilitation LOS and lower functional gain. We suggest that the presence of OH should be considered when setting up the rehabilitation plan, to include management of OH.

Multiple Days of Monitoring Are Needed to Obtain a Reliable Estimate of Physical Activity in Hip-Fracture Patients

2014 ◽  
Vol 22 (2) ◽  
pp. 173-177 ◽  
Author(s):  
Kristin Taraldsen ◽  
Beatrix Vereijken ◽  
Pernille Thingstad ◽  
Olav Sletvold ◽  
Jorunn L. Helbostad
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Community Dwelling ◽  
Reliable Estimate ◽  
Large Variability ◽  
Hip Fracture Surgery ◽  
Community Dwelling Older Adults ◽  
Mean Time ◽  
Fracture Surgery ◽  
Monitoring Activity

The aim of the study was to investigate the precision of estimated upright time during one week in community-dwelling older adults after hip fracture when monitoring activity for different numbers of consecutive days. Information about upright time was collected by thigh-worn accelerometers during 7 consecutive days in 31 older adults (mean age 81.8 years ± 5.3) 3 months after hip-fracture surgery. Mean time in upright position, including both standing and walking, was 260.9 (±151.2) min/day. A cutoff value of half an hour was used to provide recommendations about number of recording days. Large variability between participants between days, as well as a nonconstant within-participant variability between days indicates that at least 4 consecutive days of recording should be used to obtain a reliable estimate of upright time for individual persons. However, at a group level, one day of recording is sufficient.

scholarly journals Use of the Frailty Tools Fi Mds and Fi Rockwood to Predict Outcomes of Inpatient Rehabilitation after Proximal Hip Fracture

2021 ◽  
Vol 8 (3) ◽  
pp. 01-06
Author(s):  
Jochanan Naschitz
Keyword(s):  
Hip Fracture ◽  
Clinical Decision Making ◽  
Frailty Index ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Elderly Persons ◽  
Clinical Frailty Scale ◽  
The Mean ◽  
The Impact

Background Among factors which affect the outcome of rehabilitation after hip fracture, the role of pre-fracture frailty has not been defined. Objective To assess the impact of frailty on rehabilitation outcome in elderly persons with proximal hip fracture. Setting Geriatric rehabilitation center. Design Retrospective observational study. Subjects Forty consecutive patients with proximal hip fracture. Methods The following parameters were calculated: FI-MDS frailty index, Rockwood Clinical Frailty Scale (FI Rockwood), Functional Independence Measure (FIM) on discharge, absolute functional gain (ΔFIM), length of stay (LOS), and FIM gain per day (ΔFIM/LOS). FIM discharge ≥90 and motor FIM discharge >58 indicated success in rehabilitation. Results There were 31 women and 9 men, mean age 80 years. The mean pre-fracture FI MDS was 10 points (SD 5.8) out of 58 possible, the mean FI Rockwood score was 3 (SD 1.7) out of 7 possible. The mean admission FIM was 76.6 (SD 16), the mean discharge FIM was 92.7 (SD 19.3), mean LOS 22.5 days (SD 9.7), mean ΔFIM/LOS 0.8 (SD 0.6). Pre-fracture frailty was associated with worse outcome of rehabilitation: FI MDS predicted discharge FIM ≥90 with OR 0.86, p 0.012; FI Rockwood predicted discharge FIM ≥90 with OR 0.68, p 0.027; FI MDS predicted discharge motor FIM >58 with OR 0.91, p 0.07; FI Rockwood predicted discharge motor FIM >58 with OR 0.71, p 0.027. Conclusions Though pre-fracture frailty correlated with FIM on discharge, neither frailty tool was specific enough to predict success in rehabilitation and the necessary length of rehabilitation. Translating frailty scores in tools adequate for clinical decision making remains an aim for future studies.

scholarly journals Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment

Dementia ◽  
2020 ◽  
pp. 147130122096961
Author(s):  
Katherine S McGilton ◽  
Shirin Vellani ◽  
Nancy Zheng ◽  
Daniel Wang ◽  
Lydia Yeung ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Healthcare Professionals ◽  
Sampling Strategy ◽  
Inpatient Rehabilitation ◽  
Healthcare Team ◽  
Hip Fracture Surgery ◽  
Essential Components ◽  
The Individual ◽  
Fracture Surgery

Background and Objectives Despite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI. Research Design and Methods Sixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data. Findings HCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support. Discussion and Implications Rehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.

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