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Evaluation of Rehabilitation Outcomes in Older Patients with Hip Fractures

Jones, Gareth R. MSc; Miller, Thomas A. MD; Petrella, Robert J. MD, PhD

American Journal of Physical Medicine & Rehabilitation: July 2002 - Volume 81 - Issue 7 - p 489-497
Research Articles

Jones GR, Miller TA, Petrella RJ: Evaluation of rehabilitation outcomes in older patients with hip fractures. Am J Phys Med Rehabil 2002;81:489–497.

Objective This study evaluated functional outcomes in patients with hip fracture after inpatient rehabilitation.

Design The physical and cognitive functioning of 100 patients with hip fracture were determined by using the FIM™ instrument. The Montebello rehabilitation factor score was used to reflect rehabilitative outcome. Follow-up data were collected from 44 patients by using a telephone FIM interview.

Results Discharge total FIM scores improved. The Montebello rehabilitation factor score for rehabilitation efficacy and efficiency scores both demonstrated improvement for patient function during inpatient rehabilitation. The mean motor FIM domain scores for transfer mobility and locomotion were lower at discharge compared with the domains of self-care and sphincter control. A subgroup of 44 patients showed no change in mean motor FIM domain scores.

Conclusions Inpatient rehabilitation improves overall functional independence as measured by the FIM instrument. Relative change, as measured by the Montebello rehabilitation factor score, indicated that rehabilitation outcome for locomotion was not maximized, despite exhibiting large absolute gains during inpatient rehabilitation. The improvements demonstrated at discharge were maintained at follow-up for a subgroup of 44 patients. Improved locomotion skills and maximizing ability to transfer independently are areas in which inpatient rehabilitation may be targeted to improve function in the future.

From the Canadian Centre for Activity and Aging (GRJ, RJP); the Faculties of Health Sciences (GRJ, RJP) and Medicine and Dentistry (TAM, RJP), the Departments of Family Medicine (RJP), and Physical Medicine and Rehabilitation, and the School of Kinesiology (RJP), University of Western Ontario; the Lawson Research Institute (RJP) and the Department of Physical Medicine and Rehabilitation (TAM, RJP), St. Joseph’s Health Care London; and the Musculoskeletal Rehabilitation Unit, Parkwood Hospital, London, Ontario, Canada.

Supported by Hip Hip Hooray, London, Ontario, Canada.

FIM™ is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

All correspondence and requests for reprints should be addressed to Robert J. Petrella, MD, PhD, Canadian Centre for Activity and Aging, 1490 Richmond Street, London, Ontario N6G 2M3, Canada.

© 2002 Lippincott Williams & Wilkins, Inc.