Impact of osteoarthritis on rehabilitation for persons with hip fracture

Abstract

Objective. To determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home. Methods. We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup. Results. We studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean ؎ SD length of stay for patients with OA was 18.1 ؎ 10.0 days versus 16.5 ؎ 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home. Conclusion. Persons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.

Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

“…Possible explanations include 1) increased prevalence of multiple coexisting conditions (i.e., arthritis 24 , diabetes 25 ) in older patients which increases their risk for physical disability 26 and 2) frail older hip fracture patients (whose decreased physiologic reserves increase vulnerablilty to stressors) are less likely to experience successful functional outcomes. 27 Orthogeriatric models of care involving therapeutic targets developed for the “oldest and frailest” hip fracture subgroups 28 might inform care practices for IRF patients.…”

Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study

“…Patients who scored low on the FIM on admission were more dependent in basic functional activities when compared to patients who had higher scores, and may accordingly take longer to achieve safe and independent/supervised mobility needed to return home. Admission FIM score has been found to associate with longer LOS on inpatients with hip fractures [ 37 ] and stroke [ 38 ], but whether FIM can predict LOS has not been previously examined in people following joint replacement. Our current understanding is that when there were differences in both LOS and admission FIM scores between two comparison groups with THR, the group with lower admission FIM score had longer LOS [ 12 ].…”

Inpatient Rehabilitation Outcomes in a National Sample of Medicare Beneficiaries With Hip Fracture

“…Building on previous research (Graham et al, 2008; Ottenbacher et al, 2003), this study contributes to the literature because it is, to our knowledge, the first to use the CMS Inpatient Rehabilitation Facility-Patient Assessment Instrument [IRF-PAI] dataset to examine relationships between multiple patient characteristics and rehabilitation outcomes in a national sample of Medicare beneficiaries with hip fractures who were admitted to IRFs for post-acute rehabilitation. Andersen’s Model for Health Services Use (Andersen, 2008) was used as a framework (Figure 1) for assessing individual characteristics known to influence rehabilitation outcomes in IRF patients (Ahmed, Graham, Karmarkar, Granger, & Ottenbacher, 2013; Deutsch et al, 2005; Graham et al, 2008; Herbold et al, 2011; Munin et al, 2005; Nguyen-Oghalai, Ottenbacher, Granger, Smith, & Goodwin, 2006; Ottenbacher et al, 2003; Reistetter et al, 2011). These included age, race, and gender (predisposing factors); social support (an enabling factor); functional status on admission, number of comorbidities, and tier comorbidities (need-related factors); and use of IRF services (a health behavior factor), operationalized as length of stay (LOS).…”