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Regaining Functional Independence in the Acute Care Setting Following Hip Fracture

AA Guccione, PhD, PT, is Lecturer, Department of Orthopaedics, Harvard Medical School, and Director of Physical Therapy Services, Massachusetts General Hospital, 15 Parkman St, WAC 128, Boston, MA 02114 (USA) (guccionea@a1.mgh.harvard.edu).
TL Fagerson, PT, is Clinical Supervisor, Physical Therapy Department, Malden Hospital, Malden, MA 02148. He was Senior Physical Therapist, Physical Therapy Services, Massachusetts General Hospital, when this study was conducted.
JJ Anderson, PhD, is Senior Statistician, Health Services Research and Development Field Program, Bedford Veterans Administration Medical Center, Bedford, MA 01730.

Background and Purpose. Factors that predict functional recovery in the first few days following hip fracture and that may facilitate discharge to the home directly from the acute care setting have not been identified. This study investigated the attainment of key functional milestones by patients and discharge status from an acute care hospital following hip fracture. Subjects. Subjects were 162 community-based individuals (59 men, 103 women) aged 60 years or older who were admitted to an acute care hospital following unilateral hip fracture. Methods. Data on personal, medical, surgical, hospital course, and acute rehabilitation factors as well as functional status and placement at the time of discharge were collected. Adjusted odds ratios were calculated to determine predictors of independence in seven types of transfers and ambulation activities and discharge directly to the home. Results. Subjects who ambulated independently prior to fracture, stayed longer in the acute care setting, and received physical therapy on average more than once a day had improved odds of regaining independence in bed mobility, transfers, and ambulation. Subjects who regained independence and received physical therapy on average more than once a day had improved odds of discharge directly to the home from the acute care setting. Increasing age and postoperative complications reduced the odds of discharge directly home. Conclusion and Discussion. A substantial proportion of patients with hip fracture achieve independence in bed mobility and transfers and in ambulation with a walker during the early postoperative phase, although few progress to a higher level during a short-term stay in the acute care setting. Frequency of physical therapy, among other factors, appears to improve the odds of regaining functional independence and discharge directly to the home from the acute care setting.

Key Words: Acute care • Functional outcome • Hip fractures • Physical therapy • Rehabilitation

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