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.     

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.     

Outcomes after metal-on-metal hip resurfacing: could we achieve better function?

Newman MA, Barker KL, Pandit H, Murray DW. Outcomes after metal-on-metal hip resurfacing: could we achieve better function?

Objective

To report functional outcomes after metal-on-metal (MOM) hip resurfacing.

Design

A cohort of 126 MOM hip resurfacing operations were reviewed 1 year after surgery.

Setting

Hospital trust specializing in orthopedic surgery.

Participants

Sixty-seven right and 59 left hips were reviewed in patients (N=120; 71 men, 49 women; mean age, 56±9y; range, 24-76y).

Interventions

Not applicable.

Main Outcome Measures

Administered once at follow-up. Function was measured using the Oxford Hip Score (OHS), Hip disability and Osteoarthritis Outcome Score, and UCLA Activity Score. Complications, pain, range of motion, Trendelenburg test, strength, walking, single-leg stand, stair climbing, and 10-m walk time were assessed.

Results

Overall examination was satisfactory with few complications. High functional levels were reported. The median OHS was 15 and median UCLA Activity Score 7 (active). For 25%, outcome was poor with persistent pain, reduced hip flexion (mean, 94.46°±12.7°), decreased strength (P<.001), restricted walking, and functional limitations.

Conclusions

Information about outcomes is important for patients undergoing surgery. Hip resurfacing remains an emergent technology, with further follow-up and investigation warranted. One explanation for suboptimal recovery may be current rehabilitation, originally developed after total hip arthroplasty. Rehabilitation tailored to hip resurfacing, paced for this active population and progressed to higher demand activities, may improve outcomes.     

A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery

Mallinson TR, Bateman J, Tseng H-Y, Manheim L, Almagor O, Deutsch A, Heinemann AW. A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.

Objective

To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post–acute care (PAC) rehabilitation settings.

Design

Prospective observational cohort study.

Setting

Skilled nursing facilities (SNFs; n=5), inpatient rehabilitation facilities (IRFs; n=4), and home health agencies (HHAs; n=6) from 11 states.

Participants

Patients with total knee (n=146) or total hip replacement (n=84) not related to traumatic injury.

Interventions

None.

Main Outcome Measure

Self-care and mobility status at PAC discharge measured by using the Inpatient Rehabilitation Facility Patient Assessment Instrument.

Results

Based on our study sample, HHA patients were significantly less dependent than SNF and IRF patients at admission and discharge in self-care and mobility. IRF and SNF patients had similar mobility levels at admission and discharge and similar self-care at admission, but SNF patients were more independent in self-care at discharge. After controlling for differences in patient severity and length of stay in multivariate analyses, HHA setting was not a significant predictor of self-care discharge status, suggesting that HHA patients were less medically complex than SNF and IRF patients. IRF patients were more dependent in discharge self-care even after controlling for severity. For the full discharge mobility regression model, urinary incontinence was the only significant covariate.

Conclusions

For the patients in our U.S.-based study, direct discharge to home with home care was the optimal strategy for patients after total joint replacement surgery who were healthy and had social support. For sicker patients, availability of 24-hour medical and nursing care may be needed, but intensive therapy services did not seem to provide additional improvement in functional recovery in these patients.     

Long-Term Outcomes of Joint Replacement Rehabilitation Patients Discharged From Skilled Nursing and Inpatient Rehabilitation Facilities

DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Hsieh C-H, Gassaway J, Smith P. Long-term outcomes of joint replacement rehabilitation patients discharged from skilled nursing and inpatient rehabilitation facilities.

Objective

To examine functional and health status outcomes of patients with joint replacement discharged from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).

Design

Postdischarge follow-up interview study at 7.5 months after admission.

Setting

Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs.

Participants

Patients (N=856): 561 with knee replacement and 295 with hip replacement.

Interventions

None.

Main Outcome Measures

FIM and Short-Form 12-Item Health Survey (SF-12).

Results

Among patients with knee and hip replacement, IRF patients made larger motor FIM gains from admission and discharge to follow-up. IRF patients, however, were admitted with lower FIM scores and also had more to gain (especially given the ceiling effects within the FIM at follow-up). When adjusted for case mix, IRF patients made larger motor FIM gains and had higher SF-12–related scores among patients with hip replacement but not among patients with knee replacement. Multivariate regressions found modest setting effects that favored IRFs, and the setting effects explained only a modest portion of the variance in motor FIM outcomes.

Conclusions

At follow-up, patients with joint replacement discharged from IRFs had better motor FIM outcomes than those discharged from freestanding SNFs and the hospital-based SNF. Settings did not differ materially in terms of SF-12 outcomes. Findings do not favor one setting decisively over another. A sole focus on initial postacute placement overlooks the larger trajectory of postacute care that needs to be managed to achieve superior outcomes.     

Satisfaction with medical rehabilitation in patients with cerebrovascular impairment

OBJECTIVE: Overall satisfaction has important social and economic implications for patients who have received inpatient medical rehabilitation. We conducted this study to examine the overall satisfaction level at 3- to 6-mo follow-up for inpatients with cerebrovascular impairments discharged from medical rehabilitation. DESIGN: The study was retrospective using information from a national database representative of medical rehabilitation patients across the United States. Information submitted in 1997 and 1998 to the Uniform Data System for Medical Rehabilitation by 177 hospital and rehabilitation facilities from 40 states was examined. The final sample included 8,900 patient records. The main outcome measure was the level of satisfaction with medical rehabilitation at 80-180 days postdischarge follow-up. RESULTS: A logistic regression model including ten independent variables was used to predict satisfied vs. dissatisfied at follow-up. Three statistically significant variables were included in the final model and correctly classified 95.1% of the patients. Higher FIM instrument discharge scores were associated with increased satisfaction. Further analysis of the FIM instrument subscales indicated that higher ratings in transfers, social cognition, and locomotion were significantly associated with increased satisfaction. CONCLUSION: We identified several functional variables associated with increased satisfaction after medical rehabilitation in persons with stroke. The ability to objectively assess patient satisfaction is important as consumer-based outcome measures are integrated in accreditation and healthcare evaluation.     

并发症警示教育联合康复护理在髋关节置换术患者中的应用

目的 探究并发症警示教育联合康复护理在髋关节置换术患者中的应用效果.方法 选取2018年1月—2020年1月髋关节置换术患者120例,按照患者性别、年龄、病理类型、置换位置比较具有可比性的方法分为对照组与观察组,每组60例.对照组采取常规护理,观察组在对照组基础上增加并发症警示教育联合康复护理,比较两组患者的髋关节功能...     

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.     

全髋关节置换术后家庭强化康复的研究分析朱勇敢

目的: 前瞻性研究全髋置换术后行早期家庭强化康复训练对髋关节功能恢复的影响。方法：选取2011年10月至2012年3月我院髋关节骨关节炎患者52例,随机分为对照组和观察组,每组26名患者。术后12周内观察组进行弹力绳抗阻力家庭强化康复训练,对照组进行常规康复训练。术前、术后3月评估髋关节功能Harris评分、髋关节外展肌肌力。结果：观察组中有2名患者因强化康复致膝、髋疼痛,退出研究。术后3月观察组和对照组髋关节功能Harris评分和外展肌肌力均较术前有明显改善。其中,观察组恢复情况显著优于对照组。结论：术后家庭强化康复训练对髋关节置换早期关节功能恢复的优于传统的常规康复方法。     

Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients

OBJECTIVE: To identify the factors associated with inpatient rehabilitation outcome after surgical repair of hip fracture in elderly patients. DESIGN: A noninterventional prospective cohort study. SETTING: Geriatric inpatient rehabilitation center in a tertiary university medical center in southern Israel. PARTICIPANTS: Patients (N=946) aged 65 years of age or older who were hospitalized for rehabilitation after surgery for hip fracture. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional studies by the FIM instrument and a broad spectrum of clinical, demographic, and social variables. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the percentage change in the FIM score during the course of rehabilitation in relation to the severity of the functional impairment at its inception. RESULTS: Eight variables were significantly and independently associated with rehabilitation outcome. Prefracture FIM scale (standardized regression coefficient in multiple regression [beta]=.261, P<.001), serum albumin at discharge (beta=.222, P<.001), Folstein Mini-Mental State Examination (beta=.174, P<.001), visual impairment (beta=-.089, P=.002), dyspnea at mild exertion (New York Heart Association class III) (beta=-.080, P=.005), age (beta=-.080, P=.007), poststroke motor impairment (beta=-.072, P=.011), and decreased serum folic acid (beta=-.055, P=.047). The total percentage of the explained variance of the primary rehabilitation outcome measure accounted for by these 8 variables (adjusted R(2)) was 31.9%. CONCLUSIONS: The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 clinical and nutritional correctable parameters. The other 4 variables that are associated with the process cannot be corrected but may help predict outcomes and adjust expectations.     

Outcomes after inpatient rehabilitation of primary and revision total hip arthroplasty

OBJECTIVE: To compare the outcomes of patients who have gone to inpatient rehabilitation after primary total hip arthroplasty (THA) and revision THA. DESIGN: Retrospective, comparative study. SETTING: Fifty-bed freestanding, university-affiliated rehabilitation hospital. PARTICIPANTS: Two hundred fifty-five male and female primary THA patients and 147 male and female revision THA patients. INTERVENTION: Interdisciplinary inpatient rehabilitation. MAIN OUTCOME MEASURES: Length of stay (LOS), FIM instrument score and FIM motor score components, hospital charges, and discharge disposition location. RESULTS: FIM scores improved from admission to discharge by 29.7 and 27.9 points for the primary THA and revision THA groups, respectively (P<.05). LOS was shorter for primary THA patients compared with revision THA patients (10.0d vs 11.5d, P<.05). FIM efficiency (DeltaFIM/LOS) was greater for primary THA compared with revision THA (3.4 and 2.7 points/day, P<.05). Total rehabilitation hospital charges were 11,421 US dollars and 13,707 US dollars for the primary and revision THA groups, respectively, with the mechanical and infection revision THAs incurring the greatest charges (14,596 US dollars and 15,386 US dollars, respectively; P<.001). Compared with primary THA, revision THA patients were twice as likely to be discharged to locations other than home. CONCLUSIONS: FIM score improvement was lower and LOS and hospital charges were greater in revision THA than in primary THA after rehabilitation. Infection revision THA patients gained less functional independence and were discharged home less often than mechanical or pain revision THA patients; finally, infection and mechanical revision THA accrued the highest hospital charges.     

舒适护理对高龄髋关节置换患者术后康复锻炼依从性的影响

目的 探讨舒适护理对高龄髋关节置换患者术后康复锻炼依从性的影响.方法 选取我院2007年4月至2010年10月收治的60岁以上的老年髋关节置换患者76例作为研究对象,分为对照组与研究组各38例,分别行常规护理及舒适护理,并对2组护理效果进行对比.结果 在患者的护理满意度方面,患者临床舒适度与感染、假体脱位等并发症方面,以及患者手术后康复锻炼依从性方面研究组都显著优于对照组.结论 舒适护理通过临床分析有效考虑患者需求进行个性化护理,极大地增强了患者的临床舒适感、预后效果及对护理工作的满意度,提高了护理质量.     

Impact of transfer delays to rehabilitation in patients with severe trauma

OBJECTIVE: To measure the effect on rehabilitation outcomes of administrative delays in transferring patients from a level I trauma center to inpatient rehabilitation. DESIGN: Retrospective cohort study. SETTINGS: Level I trauma center and an inpatient rehabilitation center in Quebec, Canada. PARTICIPANTS: A total of 289 patients with severe trauma admitted to inpatient rehabilitation from a level I trauma center between 1994 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay (LOS) in rehabilitation, motor and cognitive function at discharge from rehabilitation, interruptions in rehabilitation, and disposition at discharge. RESULTS: Shorter administrative delays were associated with shorter rehabilitation LOS (P<.01) improved cognitive function (P=.02) and had a negative but statistically nonsignificant association with motor function at discharge. No effect was observed for rehabilitation interruptions or dispositions at discharge. CONCLUSIONS: Transferring trauma patients more quickly to inpatient rehabilitation can affect rehabilitation outcomes positively. It can also lead to an economy of resource use in both acute and rehabilitation settings.     

Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial

OBJECTIVE: To investigate the effects of a late-phase exercise program for patients who underwent total hip arthroplasty (THA) 4 to 12 months earlier. DESIGN: A single-blind, randomized controlled trial. SETTING: Exercises were performed in subjects' homes. Exercise instruction and measurements taken before and after the trial were performed in an outpatient research and treatment center. PARTICIPANTS: Convenience sample of 34 adults 4 to 12 months post-THA randomly allocated to experimental or control groups. Twenty-eight subjects completed the study. INTERVENTION: An 8-week, hip-exercise intervention, during which the control group received basic isometric and active range of motion exercises; the experimental group received strength and postural stability exercises. MAIN OUTCOME MEASURES: Score on the 12-Item Hip Questionnaire; fear of falling; hip flexor, extensor, abductor, and knee extensor muscle torque; and postural stability in single stance. RESULTS: There was a statistically significant improvement in all measures of self-perceived function, muscle strength (hip flexors, 24.4%; hip extensors, 47.8%; hip abductors, 41.2%; knee extensors, 23.4%), and postural stability (36.8%) in the experimental group and no significant change in the control group. Neither group had statistically significant changes in fear of falling measures. CONCLUSIONS: An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength, postural stability, and self-perceived function in patients 4 to 12 months after THA.     

Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke

OBJECTIVE: To examine the relation between left unilateral spatial neglect (USN) and rehabilitation outcomes in patients with right hemisphere stroke. DESIGN: A retrospective analysis of a database of right hemisphere stroke patients. SETTING: Acute inpatient rehabilitation hospital. PARTICIPANTS: Patients (N=175) with a diagnosis of right hemisphere stroke who had undergone a neuropsychologic screening including assessment of USN and depressive symptoms at time of admission to an inpatient rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional status was evaluated with the FIM instrument at admission and discharge. The relationship between USN, depressive symptoms, cognitive functioning, length of stay (LOS), and rate of progress in rehabilitation was examined via univariate (correlational) and multivariate (Cox regression) analyses. RESULTS: Patients with USN had longer LOS and progressed more slowly compared with those without USN. When matched against patients with equally poor functional status at admission, USN patients still had longer admissions and progressed more slowly. CONCLUSIONS: USN is a unique predictor of rehabilitation outcomes in patients with right hemisphere stroke. Identification of those specific functional skill areas most affected by USN may make possible the development of targeted interventions aimed at these key areas.     

Computerized biofeedback knee goniometer: acceptance and effect on exercise behavior in post-total knee arthroplasty rehabilitation

OBJECTIVE: To assess device accuracy, patient acceptance, and effect of a computerized biofeedback knee goniometer (CBG), on patients' compliance with active range of motion (AROM) exercises after total knee arthroplasty (TKA). DESIGN: Two-stage study: measurement validation on asymptomatic controls and an unblinded, multiple crossover trial. SETTING: Inpatient rehabilitation. PARTICIPANTS: Asymptomatic controls (n=14) and post-TKA inpatients (n=11). INTERVENTIONS: For measurement validation, CBG-angle measurements were compared with manual, clinician-obtained angles. To assess motivational effect, the CBG was worn after TKA; on alternating days, it either monitored AROM silently (no feedback) or provided audiovisual feedback about reaching preset range of motion (ROM) goals and prompted the patients to exercise when idle. MAIN OUTCOME MEASURES: To assess accuracy, the device's readings were compared with manual measurements. Patient satisfaction was determined by a self-report questionnaire; exercise compliance was assessed by calculating activity rate and stratified interactivity intervals. RESULTS: CBG readings reproduced clinician measurements reliably between 0 degrees and 100 degrees (eta(2)=98.5%). Auditory feedback was more helpful than visual feedback for motivating exercise. During feedback-on days, the mean total activity rate +/- standard deviation was 15.1+/-10.9 activity counts per hour, and the interactivity interval was 6.7+/-5.7 minutes. The activity rate was higher on feedback-off days-22.5+/-11.1 counts/hour (P=.11)-and the mean interactivity interval was 3.6+/-2.7 minutes (P=.07). CONCLUSIONS: The CBG provided reliable, unbiased estimates of clinician measurements of joint angle within the range of 0 degrees to 100 degrees. The CBG was accepted well by most patients. Surprisingly, slightly more ROM activity was noted during feedback-off days than feedback-on days.     

医联体结合录像指导对老年髋关节置换术患者院外康复的效果观察

目的:探讨医联体结合录像指导对老年髋关节置换术患者院外康复的效果观察。方法:采用便利抽样法,选择2018年3月—2019年6月在郑州大学第一附属医院骨科住院行髋关节置换术的58例老年患者为研究对象,随机分为观察组和对照组,每组各29例。对照组采取常规院外康复管理,观察组予以医联体结合录像指导的院外康复管理。比较干预前后...     

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.