Exploring the Effectiveness of PAC Rehabilitation for Elders with Hip Surgery: A Retrospective Study

Abstract

Background Hip fractures are high risk and high-impact events in the elderly population; despite orthopedic hip surgery, the disability and mortality rate remains significant. The National Health Insurance Agency in Taiwan established a fragility fracture PAC rehabilitation program to provide functional recovery for these patients after the surgery. However, the current literature on PAC rehabilitation is outdated, and there is an urgent need for the re-evaluation of the program. Methods This is a retrospective cohort study that enrolled 159 patients in the PAC rehabilitation program, followed by hip repair surgery. Outcome measures were the differences in participants’ pre- and post-PAC scores in 1) Barthel index, 2) Numerical Rating Scale (NRS), and 3) Harris Hip Scores (HHS) as surrogate indicators of the functional status, followed by the analysis of subgroups, including sex, age, site of the fracture, type of procedure, and the number of comorbidities. Results After completing PAC rehabilitation, 86.2% of the patients successfully returned to the community with either home or out-patient rehabilitation. The re-admission rate was 3.1% and 3.8% in 14-days and in 30-days follow up, respectively. The difference in pre- and post-Barthel index, NRS, and HHS showed significant improvement (p<0.001), without significant variations between the subgroups. Additionally, the Barthel index showed a positive correlation to HHS and a negative correlation to NRS. Conclusion This study revealed that the current form of post-surgery fragility fracture PAC program effectively improves functional status, reduces the re-admission rate, and facilitates the patient transition back to the community. The results should improve patients’ and physicians’ confidence in such a program.

Exploring the Effectiveness of PAC Rehabilitation for the Patients with Traumatic Brain Injury : A Retrospective Study

“…The Pre-PAC Barthel index was positively correlated with HHS (Pearson correlation coefficient=0.19p<0.05). The Barthel index was negatively correlated with NRS after PAC (Pearson correlation coefficient = −0.33, p < 0.01) and positively correlated with HHS (Pearson correlation coefficient = 0.44, p < 0.01)(Yang et al, 2021). As mentioned in this study, the Pre-PAC Barthel index was positively correlated with IADL (Pearson correlation coefficient = 0.332, p<0.000***).…”

“…This finding is similar to another series study in Taiwan, which showed that up to 86.2% of patients successfully returned home or community after completing the PAC-Fragility Fracture Program; The 14-day readmission rate was 3.1%. It is critical to recognize the impact of comorbidities on functional and mortality outcomes in patients with hip fractures (Yang et al, 2021). A three-year observational study showed that the number of comorbidities was significantly associated with an increase in mortality at 1 and 3 years of follow-up 3 .…”

Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery?

“…Early detection of minor symptoms prevents major problems. Therefore, PAC lowered emergency department visits and readmission rate [ 25 , 26 ]. Data on the patients’ underlying illness were also reviewed.…”

Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients

“…Furthermore, only 25% of patients can return to their pre-injury functional status, > 56% are left with severe disability, 50% require mobility aids, and only 53.9% can walk independently [26]. Moreover, 86.2% of patients who underwent rehabilitation at an early stage were able to successfully return to life in society [27]. Rehabilitation programs after hip fracture surgery can be effective in improving hip function, the ability to perform activities of daily living, pain, and mortality in patients [27][28][29].…”

“…Moreover, 86.2% of patients who underwent rehabilitation at an early stage were able to successfully return to life in society [27]. Rehabilitation programs after hip fracture surgery can be effective in improving hip function, the ability to perform activities of daily living, pain, and mortality in patients [27][28][29]. However, the clinical benefits of different exercise treatment interventions are not the same as they depend on the type, frequency, and intensity of the rehabilitation exercise and the differences in the fitness level of the patient.…”