Short-Term Outcomes of Interdisciplinary Hip Fracture Rehabilitation in Frail Elderly Inpatients.

Abstract

Objective: To investigate short-term outcomes of an interdisciplinary rehabilitation program for elderly inpatients who underwent surgical treatment for hip fractures.

Methods: This is a prospective cohort study of fifty older inpatients who were admitted to a geriatric rehabilitation unit. Clinical and functional outcomes were assessed at admission, at discharge, and one month postdischarge.

Results: Patients mean age was 84.1 ± 4.7 years. Proportions of study population with risk factors of frailty were cognitive impairment (64%), Charlson comorbidity index > 1 (72%), and protein malnutrition (59.2%). Before fracture, Barthel median was 90 (IQR 85, 100), and functional ambulation classification (FAC) score was ≥ 4 for 90% of study participants. One month after concluding rehabilitation, Barthel median was 80, 1 month postdischarge FAC ≥ 4 - prefracture FAC ≥ 4 mean change was - 8% (95% CI, -21.5%, 3.4%), and average for gait speed was 0.48 ± 0.18 m/s (95% CI, 0.43, 0.54). Significant correlation was found between admission Barthel score and 1 month postdischarge Barthel score (ρ= 0.27, p=0.05), and between prefracture FAC score and FAC score 1 month postdischarge (ρ = 0.57, p = 0.05). According to regression analysis, age, cognitive status, prefracture Barthel, prefracture FAC, type of surgery, and length of stay were associated with short-term recovery outcomes.

Conclusion: An early interdisciplinary rehabilitation management was insufficient to recover prefracture functional status. Future studies should investigate the best therapeutic strategies to optimize functional recovery, according to clinical and prefracture frail conditions of these patients.