Effect of comorbidity on functional recovery after hip fracture in the elderly

摘要

Objective: The aim of this study was to assess the relationship between selfreported disease burden (stroke, congestive heart failure, diabetes, chronic obstructive pulmonary disease, arthritis, or cancer) and functional improvement during and after inpatient rehabilitation among older adults with hip fractures. Design: This is a longitudinal study examining 238 community-dwelling adults 65 yrs or older with unilateral hip fractures who underwent surgical repair and inpatient rehabilitation and were followed for 1 yr after discharge from the inpatient rehabilitation facility. The Functional Independence Measure (FIM) instrument was the outcome variable, collected at inpatient rehabilitation facility admission and discharge and at 2, 6, and 12 mos after discharge from the inpatient rehabilitation facility. A mixed-effect model was applied to quantify FIM functional improvement patterns between groups with and without selected preexisting chronic conditions while adjusting for potential confounders. Results: Maximum functional improvement occurred during rehabilitation and the first 6 mos after rehabilitation for all six chronic conditions under study. In regard to the effect of disease on selected FIMoutcomes, comparedwith patientswithout the selected preexisting chronic conditions, those who have had a stroke had significantly worse self care (β = j0.33; P = 0.02), transfer (β = j0.36; P = 0.03), and locomotion (β = j0.84; P = 0.0005) ratings, whereas the patients with congestive heart failure had significantly worse transfer (β =j0.59; P=0.001) and locomotion (β =j0.71; P = 0.01) ratings. Significant interactions in stroke with time were seen in self-care (β = j0. 03; P = 0.04), suggesting that those who have had a stroke before hip fracture had poorer functional improvement over time than those who did not have the conditions. The patients with congestive heart failure demonstrated a faster rate of recovery over time in locomotion than those without (β = 0.06; P = 0.03). Conclusions: Intervention strategies shouldmonitor the first 6 mos after discharge from inpatient rehabilitation, during which the maximum level of functional improvement is expected. However, the individuals who have had a stroke had poor functional improvement at 1 yr (adjusted mean FIM score, 5.74) than those who have not had a stroke (adjusted mean FIM score, 6.56). The patients who have had a stroke required human supervision at 12 mos after rehabilitation. Therefore, long-term care needs should be monitored in the discharge plan.