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