Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture

OBJECTIVE: To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture. SETTING: Geriatric rehabilitation center. PARTICIPANTS: One hundred thirty-three older patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS). RESULTS: Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home. CONCLUSIONS: Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.     

Rehabilitation outcome following hip fracture surgery in elderly diabetics: A prospective cohort study of 224 patients

Purpose.?To characterize the course and outcome of rehabilitation following hip fracture (HF) in elderly diabetic patients.

Method.?A non-interventional prospective cohort study of 224 elderly diabetic patients who were hospitalized for rehabilitation, compared to 738 non-diabetic patients. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the rehabilitation outcome.

Results.?The absolute efficacy of rehabilitation was lower in diabetics vs. non-diabetics (28.8 ± 20.0 vs. 31.8 ± 18.4, respectively, p = 0.04). This difference was caused by a significantly lower pre-event Functional Independence Measure (FIM?) (112 ± 17 vs. 115 ± 14, p = 0.002) and a significantly higher rate of prior stroke with motor impairment (16% vs. 7%, p < 0.0001). No significant difference was found between the study groups for various rehabilitation-related complications, including mortality. None of the 12 specific variables associated with diabetes or its complications was significantly and independently associated with the outcome of rehabilitation among diabetics.

Conclusions.?The outcome of rehabilitation in elderly diabetic patients following HF is significantly worse than in non-diabetics. This result stems from the poor pre-event functional state of these patients. The results of this study can help to predict the outcome of rehabilitation in elderly diabetic patients who are candidates for rehabilitation following surgical repair of HF.     

Effect of rehabilitation site on functional recovery after hip fracture

OBJECTIVE: To evaluate whether FIM instrument motor outcomes differ between hip fracture survivors undergoing rehabilitation in inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs). DESIGN: Inception cohort with follow-up to 12 weeks after hospital discharge. SETTING: University-affiliated tertiary care hospital, IRFs, and SNFs. PARTICIPANTS: All hip fracture patients prospectively admitted between March 1, 2002, and June 30, 2003, were eligible if they were 60 years or older and had surgical stabilization of the fracture. INTERVENTIONS: Posthip fracture rehabilitation delivered at either IRFs or SNFs. MAIN OUTCOME MEASURE: FIM motor score obtained postoperatively and at 2 and 12 weeks posthospital discharge. RESULTS: IRF patients stayed an average of 12.8 days, whereas SNF patients averaged 36.2 days. Rehabilitation participation scores were obtained during therapy sessions and did not differ between groups. A repeated-measures analysis of covariance found a significant group by time interaction (F 2,68 =23.75, P <.001), which indicates that patients in an IRF had significantly higher FIM motor scores than those in an SNF across time. Logistic regression showed that IRF subjects were more likely to reach 95% of their prefracture FIM motor by week 12 than were SNF patients. A significantly higher percentage of IRF patients were discharged home after rehabilitation compared with SNF patients. CONCLUSIONS: IRF patients had superior 12-week functional outcomes, as measured by the FIM motor score, compared with those treated in an SNF. The improved outcomes occurred during a significantly shorter rehabilitation length of stay and remained even when statistically controlling for baseline differences between groups. These data suggest that hip fracture survivors should not be excluded from receiving inpatient rehabilitation services. Randomized clinical trials are needed to understand more fully differences between rehabilitation treatment settings.     

The impact of previous strokes on the rehabilitation of elderly patients sustaining a hip fracture

OBJECTIVE: To evaluate whether a previous stroke may affect the functional outcome gain of elderly patients undergoing rehabilitation for a hip fracture. DESIGN: A retrospective cohort study. SETTING: The division of geriatric medicine with rehabilitation wards at a university-affiliated referral hospital. PARTICIPANTS: Patients with hip fractures (N=460) undergoing a standard rehabilitation course. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The functional outcome of previous stroke- and nonprevious stroke (NPS)-affected patients assessed by the FIM instrument at admission and discharge from the rehabilitation facility. Data were analyzed by t tests, Pearson correlation, chi-square tests, and linear regression analysis. RESULTS: Both admission and discharge total FIM scores were significantly higher in NPS compared with previous stroke patients (63.53+/-19.89 vs 52.19+/-19.37, P<.001) and (84.23+/-24.93 vs 71.37+/-25.03, P=.001), respectively. However, changes in total FIM (20.70+/-11.68 vs 19.17+/-13.32, P=.38) and in motor FIM (19.84+/-10.63 vs 17.96+/-11.21, P=.23) at discharge were not statistically significant between the 2 groups. A linear regression analysis showed that a previous stroke was not predictive of a worse total FIM gain at discharge (P=.58). CONCLUSIONS: NPS hip fracture elderly patients show higher admission and discharge FIM scores compared with previous stroke patients. Nevertheless, both groups achieve similar FIM gains during rehabilitation period. A previous stroke should not be considered as adversely affecting the rehabilitation of such patients.     

Improvement in aerobic fitness during rehabilitation after hip fracture

Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture.

Objective

To evaluate the effect of an upper-body exercise program on cardiorespiratory fitness in older adults with hip fracture during inpatient rehabilitation.

Design

Randomized controlled trial using a convenience sample.

Setting

An inpatient rehabilitation unit.

Participants

Twenty older patients (age, 81.3±7.2y; 14 women).

Intervention

Patients were randomly assigned to a control group (n=10) or a training group (n=10). Both groups attended physical and occupational therapy sessions 5 times a week during rehabilitation (mean length of stay, 32.9±5.3d). Patients in the training program used an arm crank ergometer 3 times a week for 4 weeks.

Main Outcome Measure

Peak oxygen consumption (Vo₂peak).

Results

Vo₂peak increased significantly in the training group (8.9±1.4 to 10.8±1.7mL·kg⁻¹·min⁻¹) and did not change in the control group (8.9±1.2 to 8.8±1.6mL·kg⁻¹·min⁻¹). At discharge, both groups were significantly improved in all functional outcome measures (Timed Up & Go [TUG] test, Berg Balance Scale [BBS], FIM instrument, two-minute walk test [2MWT], and ten-minute walk test [10MWT]). The training group performed significantly better in mobility (TUG, 2MWT, 10MWT) and balance (BBS) compared with the control group. There was a significant correlation between Vo₂peak and the 2MWT (r=.81) and 10MWT (r=.85) in the training group at discharge.

Conclusions

The upper-body exercise program had a significant effect on aerobic power. Our results suggest that aerobic endurance exercise should be integrated into standard rehabilitation to enhance patients’ aerobic fitness and mobility after hip fracture surgery.     

骨折类型与老年髋部骨折术后疗效分析

目的探讨老年髋部骨折类型对术后疗效的影响。方法 2007年4月至2008年11月收治老年髋部骨折患者121例。入组后根据X线表现将髋部骨折分为非移位型股骨颈骨折、移位型股骨颈骨折、稳定型股骨转子间骨折和非稳定型股骨转子间骨折四种。详细记录患者并存症、手术细节、术后并发症等。观察四组患者住院期间、术后6个月、12个月四种骨折患者的死亡率以及功能恢复情况。结果符合入选标准93例,其中不稳定型股骨转子间骨折22例,稳定型股骨转子间骨折30例,移位型股骨颈骨折19例,非移位型股骨颈骨折22例。四组患者年龄、并存症等一般情况差异无统计学意义。住院期间、术后6个月移位型股骨颈骨折患者死亡率较其他三组高,但差异无统计学意义;而术后12个月不稳定型股骨转子间骨折患者死亡率较其他三组明显升高。此外出院时移位型股骨颈骨折患者ADL评分较其他三组明显升高;术后6个月、12个月四组患者ADL评分差异无统计学意义。结论排除自身差异后,髋部骨折类型对术后疗效具有一定影响。早期(住院期间、术后6个月)移位型股骨颈骨折死亡率较其他三种类型骨折高,晚期(术后12个月)不稳定型股骨转子间骨折死亡率较其他三种类型髋部骨折高。骨折类型对术后功能恢复...     

Analysis of muscle atrophy after hip fracture in the elderly

Ogawa H, Oshita H, Ishimaru D, Yamada K, Shimizu T, Koyama Y, Akaike A, Hori H. Analysis of muscle atrophy after hip fracture in the elderly.

Objectives

To examine the relationship between muscle atrophy, ambulatory ability, and fracture type, and to make a specific rehabilitation regimen for each fracture type.

Design

Observational study.

Setting

Public hospital.

Participants

Consecutive patients (N=53) with hip fracture (mean age, 83.6y) who underwent operative treatment.

Interventions

Not applicable.

Main Outcome Measures

The ambulatory ability score and the cross-sectional areas of lower-limb muscles as measured on computed tomography scans.

Results

Muscle atrophy was not related to fracture type. Although the mean ambulatory ability score decreased significantly from 4.5±0.3 points prior to injury to 3.0±0.6 points 1 month postadmission, the degree of muscle atrophy was not associated with the decrease in ambulatory ability.

Conclusions

It seems likely that other factors are more important than muscle atrophy and fracture type in determining recovery after surgical repair of a fracture and that there is no need for rehabilitation regimens based on fracture types.     

Pattern of functional change during rehabilitation of patients with hip fracture

OBJECTIVE: To examine the rate of functional change in 2 domains, activities of daily living (ADLs) and mobility, over 2 time periods during hip fracture rehabilitation. DESIGN: Retrospective analysis of data contained in an administrative dataset. SETTING: Seventy skilled nursing facilities (SNFs). PARTICIPANTS: People (N=351) receiving rehabilitation in SNFs from March 1998 to February 2003 after hip fractures. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Rate of change in scores in the ADL and mobility domains of the FIM instrument during 2 time intervals of rehabilitation. RESULTS: The rate of functional change across 2 time intervals was constant for mobility (mean change in FIM points per day, .46 vs .49), but declined in the second time period for ADLs (mean change in FIM points per day, .55 vs .41). Executive function, length of stay (LOS), and medical complexity were related to rate of change in mobility, and baseline ADLs, executive function, living setting, and LOS were related to rate of change in ADLs. There was an interaction between rehabilitation phase and baseline mobility. People with lower baseline mobility had an increased rate of change during the second interval (mean change in FIM points per day, .41 vs .55), whereas those with higher baseline mobility had a decreased rate of change (mean change in FIM points per day, .50 vs .43). CONCLUSIONS: The pattern of functional change over time differed for ADL and mobility domains, and for specific groups of patients. The results have implications for goal setting and discharge planning.     

Rehabilitation outcome following hip fracture surgery in elderly diabetics: a prospective cohort study of 224 patients

PURPOSE: To characterize the course and outcome of rehabilitation following hip fracture (HF) in elderly diabetic patients. METHOD: A non-interventional prospective cohort study of 224 elderly diabetic patients who were hospitalized for rehabilitation, compared to 738 non-diabetic patients. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the rehabilitation outcome. RESULTS: The absolute efficacy of rehabilitation was lower in diabetics vs. non-diabetics (28.8 +/- 20.0 vs. 31.8 +/- 18.4, respectively, p = 0.04). This difference was caused by a significantly lower pre-event Functional Independence Measure (FIM) (112 +/- 17 vs. 115 +/- 14, p = 0.002) and a significantly higher rate of prior stroke with motor impairment (16% vs. 7%, p < 0.0001). No significant difference was found between the study groups for various rehabilitation-related complications, including mortality. None of the 12 specific variables associated with diabetes or its complications was significantly and independently associated with the outcome of rehabilitation among diabetics. CONCLUSIONS: The outcome of rehabilitation in elderly diabetic patients following HF is significantly worse than in non-diabetics. This result stems from the poor pre-event functional state of these patients. The results of this study can help to predict the outcome of rehabilitation in elderly diabetic patients who are candidates for rehabilitation following surgical repair of HF.     

老年髋部骨折术后患者家庭康复护理的最佳证据总结

目的 总结老年髋部骨折术后患者家庭康复护理的相关证据,为临床工作者制订家庭康复护理方案提供参考。方法 计算机检索国内外相关指南网站、专业协会网站及UpToDate、BMJ Best Practice、乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、CINAHL、Embase、PubMed、Web of Science、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中关于老年髋部骨折术后患者家庭康复护理的相关临床决策、指南、系统评价、专家共识及证据总结,检索时限为建库至2021年10月。由2名研究者对文献进行质量评价和资料提取。结果 共纳入15篇文献,其中临床决策3篇,指南3篇,专家共识5篇,系统评价2篇,证据总结2篇。从适宜人群、出院计划、康复评估、康复预期、康复策略、强化锻炼、健康教育、随访8个方面汇总了27条最佳证据。结论 该研究总结的老年髋部骨折术后患者家庭康复护理的最佳证据较为科学、全面。建议医护人员在应用证据时,结合具体的临床情景与患者意愿制订个性化的康复护理方案。     

The association between psychotropic medication use and functional outcome of elderly hip-fracture patients undergoing rehabilitation

OBJECTIVE: To study the interrelations between use of psychotropic medications and functional outcomes of elderly hip fracture patients undergoing rehabilitation. DESIGN: A retrospective parallel group study. SETTING: A geriatric rehabilitation department in a large urban academic hospital. PARTICIPANTS: Records of 432 elderly people with extracapsular or intracapsular hip fractures were initially screened between 1999 and 2003. Of these, 263 subjects were eligible for the study. Their average age was 82.2+/-6.9 years. The average length of stay was 29.0+/-10.2 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Absolute (uncorrected) functional gains measured by the FIM instrument and relative (corrected) FIM gains calculated according to the Montebello equation. RESULTS: Of the 263 patients included in the final analysis, 153 (62.4%) were treated with psychotropics. The 2 groups were similar, yet psychotropic drug users were more likely to be women (P = .028) and to suffer intracapsular fractures (P = .027). Similar improvements in absolute FIM scores were observed during rehabilitation in both groups. However, both total and motor relative functional gains were lower in psychotropic drug users (.33+/-0.1 vs .39+/-0.1, P = .021) than in nonusers (.31+/-0.1 vs .42+/-0.2, P = .039). Regression analysis showed that female sex ( P = .029), higher Folstein Mini-Mental State Examination score (P < .001), and independent prefracture function (P < .01) were associated with higher motor FIM gains. Use of minor tranquillizers was only slightly-and adversely-associated with lower FIM gains (r = -2.68, P = .047), whereas the use of antidepressants and antipsychotics had no effect on these parameters. CONCLUSIONS: Use of psychotropic medications does not appear to be associated with functional outcome of elderly hip fracture patients undergoing rehabilitation.     

The Lower Extremity Gain Scale: a performance-based measure to assess recovery after hip fracture

OBJECTIVE: To develop and determine the reliability and validity of a sensitive observational measure to assess recovery in clinically meaningful areas of function after hip fracture. DESIGN: Used survey data to identify activities difficult to perform after fracture; conducted focus groups; interviewed patients; and developed a standardized protocol to prospectively test the highest ranking activities. SETTING: Evaluations conducted in 8 Baltimore hospitals or the patients' residence. PARTICIPANTS: Patients 2 to 24 months postfracture, 65 years and older, and community-dwelling. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Lower Extremity Gain Scale (LEGS). RESULTS: Nine performance-based activities were appropriate for administration in clinical and research settings: (1) walk 3m (10ft); put on a (2) sock and (3) shoe on the fractured side; (4) rise from an armless chair; step (5) up and (6) down 4 stairs; get (7) on and (8) off the toilet; and (9) reach for an item on the ground from a sitting position. Reproducibility is good and measures of internal consistency and content, concurrent, and construct validity are high. CONCLUSIONS: The LEGS can be easily administered by clinicians in a short time as part of care. Research and clinical scoring methods and performance norms can track recovery in activities that are most relevant in the lives of patients.     

Coordinated multidisciplinary rehabilitation after hip fracture

Purpose: To review the topic of coordinated multidisciplinary rehabilitation after hip fracture from a research perspective and to provide information to guide the provision of rehabilitation services for patients with hip fracture.

Methods: Literature review including searches of Medline, Embase, Cochrane Collaboration and evidence based clinical guidelines, checking of references of publications and consultation with researchers.

Results: The research evidence is heterogeneous and remains inclusive. Programs that assist patients with hip fracture to regain function and return home as soon as feasible are likely to be effective as they appear to increase the percentage of patients who return home and remain there after hip fracture. Rehabilitation programs that achieve this are likely to be cost effective. These programs involve health professionals from multiple disciplines (nurses, allied health professionals and medical practitioners) who work collaboratively, may operate in several settings, and routinely provide specific treatments that are supported by strong evidence of effectiveness.

Conclusions: Patients with hip fracture should be offered a coordinated a multidisciplinary rehabilitation program with the specific aim of regaining sufficient function to return to their pre-fracture living arrangements.     

Coordinated multidisciplinary rehabilitation after hip fracture

Purpose: To review the topic of coordinated multidisciplinary rehabilitation after hip fracture from a research perspective and to provide information to guide the provision of rehabilitation services for patients with hip fracture.

Methods: Literature review including searches of Medline, Embase, Cochrane Collaboration and evidence based clinical guidelines, checking of references of publications and consultation with researchers.

Results: The research evidence is heterogeneous and remains inclusive. Programs that assist patients with hip fracture to regain function and return home as soon as feasible are likely to be effective as they appear to increase the percentage of patients who return home and remain there after hip fracture. Rehabilitation programs that achieve this are likely to be cost effective. These programs involve health professionals from multiple disciplines (nurses, allied health professionals and medical practitioners) who work collaboratively, may operate in several settings, and routinely provide specific treatments that are supported by strong evidence of effectiveness.

Conclusions: Patients with hip fracture should be offered a coordinated a multidisciplinary rehabilitation program with the specific aim of regaining sufficient function to return to their pre-fracture living arrangements.     

Influence of rehabilitation site on hip fracture recovery in community-dwelling subjects at 6-month follow-up

OBJECTIVE: To evaluate whether postacute rehabilitation after hip fracture influences recovery of prefracture function as detected by the FIM instrument motor scale. DESIGN: Inception cohort. SETTING: University-affiliated tertiary care hospital; inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs). PARTICIPANTS: People with acute proximal femur fracture treated between March 1, 2002, and June 30, 2003. INTERVENTION: Post-hip fracture rehabilitation delivered at an IRF or SNF. MAIN OUTCOME MEASURE: FIM motor score estimated prefracture and obtained at 2 weeks and 24 weeks after hospital discharge. RESULTS: Fifty-eight patients were treated at an IRF, whereas 39 were treated at an SNF. Controlling for baseline covariates, a mixed model showed a significant group by time interaction (F(3,57.1)=14.27, P < .001). Contrasts indicated that IRF subjects had greater initial improvement. Multiple logistic regression examining factors associated with recovery of FIM motor score to 95% or more of prefracture FIM motor score by 24 weeks found that IRF setting only was associated with recovery of baseline function with odds ratio of 5.44 (95% confidence interval, 2.02-14.65). CONCLUSIONS: Even when controlling for important baseline covariates, community-dwelling hip fracture subjects treated in an IRF are more likely to attain 95% or more of prefracture functional status by 24 weeks postdischarge than subjects treated in an SNF.     

Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial

OBJECTIVE: To compare the effect of early discharge and home-based therapy with conventional hospital rehabilitation on patient and caregiver outcomes at 12 months after hip fracture. DESIGN: Randomized controlled trial. SETTING: Acute and subacute care with follow-up in a community setting in Australia. PARTICIPANTS: Sixty-six older adults admitted to acute care after hip fracture who were assessed as needing rehabilitation. INTERVENTIONS: Eligible patients were randomized to either home-based (n=34) or hospital (n=32) rehabilitation. Patients assigned to the home-based group were discharged home within 48 hours of randomization. Patients assigned to hospital rehabilitation received usual care. MAIN OUTCOME MEASURES: Modified Barthel Index (MBI), timed up and go (TUG) test, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index. RESULTS: At 12 months, 56 of 66 (85%) participants were available for follow-up assessment. Both groups achieved significant improvements in MBI and TUG test scores. Patients in both groups had a significant decline in the physical score of the SF-36 and there were no differences between groups. Caregivers of patients allocated to receive home-based therapy reported a reduction in burden after 12 months. Over that period, there was a significant reduction in the burden for caregivers of those patients who received home rehabilitation (P=.020). CONCLUSION: For patients who were previously functionally independent and living in the community, early return home with increased involvement of caregivers after hip fracture resulted in similar patient outcomes (home vs hospital) and less caregiver burden at 12 months.     

Scoring systems to evaluate elderly patients with hip fractures

Purpose: To report about different scales and scoring systems used to evaluate elderly patient with hip fracture during the acute post-fracture phase and during post-operative rehabilitation.

Methods and results: Report of the different scales from a literature review.

Conclusions: Standard validated scales are one of the tools to perform such an evaluation process as objectively as possible and to evaluate surgical, medical and rehabilitative management in these elderly patients. These scales are only a complementary tool, and they cannot replace physical examination. However, these validated tools are probably more accurate than just clinical impression. The appropriate combination of clinical experience and these scales may well contribute to a better care of elderly patients with hip fractures.     

Scoring systems to evaluate elderly patients with hip fractures

Purpose: To report about different scales and scoring systems used to evaluate elderly patient with hip fracture during the acute post-fracture phase and during post-operative rehabilitation.

Methods and results: Report of the different scales from a literature review.

Conclusions: Standard validated scales are one of the tools to perform such an evaluation process as objectively as possible and to evaluate surgical, medical and rehabilitative management in these elderly patients. These scales are only a complementary tool, and they cannot replace physical examination. However, these validated tools are probably more accurate than just clinical impression. The appropriate combination of clinical experience and these scales may well contribute to a better care of elderly patients with hip fractures.     

Clock drawing and rehabilitation outcome in hip fracture patients

Purpose.?To assess the relationship between the Clock Drawing Test (CDT) and rehabilitation outcome in hip fracture patients within normal range of the Mini Mental State Examination (MMSE).

Methods.?This retrospective study was performed in a post-acute geriatric rehabilitation centre. One hundred and forty-two patients with proximal hip fracture admitted from January 2006 to June 2008 whose MMSE scores was within normal range (>23) were enrolled in the study. The patients were divided into two groups according to CDT performance (impaired versus intact). The differences between the two groups in relation to age, gender, education level, living arrangement, pre fracture functional level, fracture type, and outcome measurements [Functional Independent Measure (FIM), motor FIM, Rate of in-hospital Improvement (RI) in FIM and motor FIM, and Length of Stay (LOS)] were assessed.

Results.?Discharge FIM score and motor FIM scores were significantly lower for the impaired CDT group (89?±?13.7 vs. 94.9?±?11.6, p?=?0.007; 61.6?±?11.1 vs. 65.7?±?9.6, p?=?0.022 respectively); LOS was significantly longer (28.2?±?7.9 vs. 25.3?±?8.5, p?=?0.033) and rates of improvement in FIM and motor FIM were significantly slower (0.62?±?0.35 vs. 0.77?±?0.45, p?=?0.036; 0.61?±?0.34 vs. 0.75?±?0.42, p?=?0.033, respectively). Nevertheless, FIM and motor FIM scores changes were similar in both CDT groups. Following adjustment for age, LOS of patients with impaired CDT was significantly longer (p?=?.027).

Conclusions.?The CDT may assist the multidisciplinary team in identifying hip fracture patients whose MMSE scores are within the normal range, but yet need a longer training period to extract their rehabilitation potential.