Original article
Does Standardized Rehabilitation and Discharge Planning Improve Functional Recovery in Elderly Patients With Hip Fracture?

https://doi.org/10.1016/j.apmr.2005.06.019Get rights and content

Abstract

Beaupre LA, Cinats JG, Senthilselvan A, Scharfenberger A, Johnston DW, Saunders LD. Does standardized rehabilitation and discharge planning improve functional recovery in elderly patients with hip fracture?

Objective

To determine whether standardized early rehabilitation and discharge planning increase risk-adjusted function and reduce risk-adjusted institutionalization in the first 6 months after hip fracture.

Design

Pre-post study of 2 independent population-based inception cohorts.

Setting

Two tertiary hospitals in an urban health region.

Participants

Patients with hip fracture (N=919) 65 years and older.

Intervention

Subjects were enrolled before (control) and after (intervention) implementation of standardized rehabilitation and discharge planning.

Main Outcome Measures

Function and institutionalization status were assessed at time of fracture and 3 and 6 months postfracture. Administrative databases provided length of stay (LOS) data.

Results

After risk-adjustment, the Barthel Index score was significantly lower 3 months postfracture in control patients with low social support compared with those with higher social support (P<.05). Social support did not affect 3-month function in the intervention cohort. Control subjects with low social support were also significantly more likely to reside in long-term care by 6 months postfracture than intervention subjects with similar social support or those with higher social support (odds ratio=3.3; 95% confidence interval, 1.4–7.5). Total LOS did not change between cohorts.

Conclusions

Overall, standardized rehabilitation and discharge planning did not affect postoperative function or institutionalization in elderly patients with hip fracture. In intervention patients with low social support, function improved and institutionalization was reduced.

Section snippets

Design

This study was a comparison of 2 independent population-based prospective cohorts from 1 health region. Data collected from a consecutive cohort of 451 patients treated using the clinical pathway between July 1999 and October 2000 served as the treatment (pathway) group. The control group consisted of a consecutive cohort of 468 patients with hip fracture treated between July 1996 and September 1997 before clinical pathway implementation.28 A pre-post study was possible because extensive data,

Demographics

Of patients admitted between July 1997 and September 1998 and between July 1999 and September 2000, 468 (69%) and 451 (68%) eligible subjects agreed to participate in the control and pathway cohorts, respectively (fig 1). Participants in both cohorts were similar in demographic, medical, and social characteristics and in prefracture function (table 1). The proportion of nonparticipants was similar between cohorts (P=.72) (see fig 1). Nonparticipants typically were men, older, sicker, and more

Discussion

The primary objective of our study was to determine how implementation of standardized rehabilitation and discharge planning during the surgical hospital stay, as part of a clinical pathway, affected functional recovery and institutionalization after hip fracture. Overall, no differences were detected between the cohorts in functional recovery at 3 months postfracture or in rate of institutionalization or LOS at 6 months postfracture. At the time of clinical pathway implementation, very little

Conclusions

The findings of our study add to the body of evidence regarding how elderly patients with hip fracture should be managed in the early postoperative period. We believe our results can be considered generalizable to urban populations of elderly patients with hip fracture because we included both community- and most institutionally based people. Standardized rehabilitation and proactive discharge planning can be applied in this patient population with positive impacts on the functional recovery

Acknowledgment

We thank Maria E. Suarez-Almazor, MD, PhD, for her assistance with the control cohort and the design of the postpathway study.

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    Supported by the Alberta Heritage Foundation for Medical Research, the University Hospital Foundation, the Royal Alexandra Hospital Foundation, and the Edmonton Orthopaedic Research Committee.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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