Indian Journal of Physical Medicine and Rehabilitation

Register      Login

VOLUME 29 , ISSUE 3 ( July-September, 2018 ) > List of Articles

Original Article

Hip Fracture Patients Referred for Rehabilitation After Surgery: Identifying Clinical Predictors for Ambulation

Tan Y Leng

Keywords : Fracture, Rehabilitation,Ambulation

Citation Information : Leng TY. Hip Fracture Patients Referred for Rehabilitation After Surgery: Identifying Clinical Predictors for Ambulation. Indian J Phy Med Rehab 2018; 29 (3):77-82.

DOI: 10.5005/jp-journals-10066-0030

License: CC BY-NC 4.0

Published Online: 00-09-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and objectives: Hip fracture patients received rehabilitation in tertiary hospital to maximize recovery after surgery. These patients achieve different ambulation status at the point of discharge. We conducted a prospective study identifying clinical factors affecting ambulation distance achieved and predictors influencing need for walking aid. Materials and methods: One hundred twenty-one hip fracture patients with hip surgery were studied during their course of inpatient rehabilitation in Singapore. Outcome measures at discharge included ambulation distance and patients who needed walking aid at the point of discharge. Results: The mean cohort age was 74.6 ± 9.9 years. Seventy-three (60.3%) were the neck of femur fractures and the rest were intertrochanteric fractures. Eightyseven (72%) had a caregiver. The mean admission functional independence measure (FIM) score was 82 ± 18. Majority (86%, n = 104) did not develop cardiac complications or urinary infection (80%, n = 97) after surgery. The average rehabilitation days were 21 ± 11. The mean ambulation distance was 56.7 ± 54.0 meters. The majority (81%, n = 98) needed walking aid at discharge despite rehabilitation. The positive predictors for better ambulation distance were the absence of renal impairment (B = 25.7, p = 0.022), a higher admission FIM (B = 1.1, p < 0.01) and those who can walk without assistance at discharge(B = 60, p < 0.01). The positive predictors for walking without aid after rehabilitation were those who do not require a caregiver (B = 0.26, p < 0.01), a shorter duration of inpatient rehabilitation (B = 0.01, p = 0.07), and those with more motor FIM gain (B = 0.01, p = 0.028). Conclusion: This hip fracture study highlights the clinical relevance of identifying positive predictors for ambulation status after surgery. Hip fracture rehabilitation units can consider these predictors to assist in devising their rehabilitation programs.


PDF Share
  1. Norton R, Butler M, Robinson E, et al. Declines in physical functioning attributable to hip fractures in the elderly: a follow-up study of case control population. Disabil Rehab 2000;22:345-351.
  2. Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization and functional status: a prospective study. Am J Public Health 1997;87:398-403.
  3. Koh GC, Tai BC, Ang LW, et al. All-cause and cause-specific mortality after hip fracture among Chinese women and men: The Singapore Chinese Health Study. Osteoporos Int 2013;24:1981-1989.
  4. Siu AL, Penrod JD, Boockvar KS, et al. Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 2006;166:766-771.
  5. Cameron ID. Coordinated multidisciplinary rehabilitation after hip fracture. Disabil Rehabil 2005;27(18-19): 1081-1090.
  6. Stucki G1, Stier-Jarmer M, Grill E, et al. Rationale and principles of early rehabilitation care after an acute injury or illness. Disabil Rehabil 2005;27(7-8):353-359.
  7. J Zhang. Who Will Walk Again? Effects of Rehabilitation on the Ambulatory Status in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture. Geriatric Orthopedic Surgery and Rehabilitation 2015;6(3)168-172.
  8. Salbach NM, O'Brien K, Brooks D, et al. Speed and distance requirements for community ambulation: a systematic review. Arch Phys Med Rehabil 2014;95(1):117-128.
  9. Bottemiller KL. FIM score, FIM efficiency, and discharge disposition following inpatient stroke rehabilitation. Rehabil Nurs 2006;31(1):22-25.
  10. Ng YS. Results from a prospective acute inpatient rehabilitation database: clinical characteristics and functional outcomes using the functional independence measure. Ann Acad Med Singapore 2007;36:3-10.
  11. Chin PH. Factors predicting rehabilitation outcomes of elderly patients with hip fracture. Hong Kong Med J 2008;14:209-215.
  12. Adunsky A. Perioperative urinary retention, short-term functional outcome and mortality rates of elderly hip fracture patients. Geriatr Gerontol Int 2015;15(1):65-71.
  13. Seng WR, Belani MH, Ramason R, et al. Functional improvement in geriatric hip fractures: does vitamin d deficiency affect the functional outcome of patients with surgically treated intertrochanteric hip fractures. Geriatr Orthop Surg Rehabil 2015;6(3):186-191.
  14. Tan WL, Low SL, Shen L, et al. Osteoporotic hip fractures: 10-year review in a Singaporean hospital. J Orthop Surg (Hong Kong) 2015; 23(2):150-154.
  15. Dennett AM. Community ambulation after hip fracture: completing tasks to enable access to common community venues. Disabil Rehabil 2012;34(9):707-714.
  16. Christine J. Porter. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. MC Nephrology BMC series – open, inclusive and trusted 2017;18:20.
  17. Salpakoski A. Walking recovery after a hip fracture: a prospective follow-up study among community-dwelling over 60-year old men and women. BioMed Research International 2014:11.
  18. Khan F, Ng L, Gonzalez S, et al. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 2008;(2): CD004957.
  19. Ng YS. Adults and Elderly with Multiple Disabilities. The Singapore Family Physicians 2014;40(2):43-55.
  20. Harty M, Griesel M, van der Merwe A. The ICF as a common language for rehabilitation goal-setting: comparing client and professional priorities. Health Qual Life Outcomes. 2011;9: 87.
  21. Thomas S. Walking aid use after discharge following hip fracture is rarely reviewed and often inappropriate: an observational study. J Physiother 2010;56(4):267-272.
  22. Benedetti MG, Ginex V, Mariani E, et al. Cognitive impairment is a negative short-term and long-term prognostic factor in elderly patients with hip fracture. Eur J Phys Rehabil Med 2015 May 22.
  23. Radinovic K, Markovic-Denic L, Dubljanin-Raspopovic E, et al. Estimating the effect of incident delirium on shortterm outcomes in aged hip fracture patients through propensity score analysis. Geriatr Gerontol Int 2015;15(7): 848-855.
  24. Stucki G, Stier-Jarmer M, Grill E, et al. Rationale and principles of early rehabilitation care after an acute injury or illness. Disabil Rehabil. 2005;27(7-8):353-359.
  25. Greenberg SE. Does admission to medicine or orthopedics impact a geriatric hip patient's hospital length of stay? J Orthop Trauma. 2015 Sep 14.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.