Mobility assessment of hip fracture patients during a post-acute rehabilitation program

摘要

Our aim was to describe improvement in mobility level in hip fracture patients during a post-acute rehabilitation program and examine variables that may impede mobility improvement. A retrospective chart review of 138 patients with a proximal hip fracture, admitted consecutively during 2006 was conducted. Main outcome measurements were: 6-meter-walking-time (6mWT), rate of improvement (RI) in the 6mWT, gait velocity (GV), functional independence measure (FIM), motor FIM (mFIM) and length of stay (LOS). Most patients (118, 85.5%) showed improvement in the 6mWT (mean 16.05 ± 20.2. s, median 12.08). At discharge, 117 patients (84.7%) achieved GV within household ambulation (<0.4. m/s). Patients with high initial GV needed shorter rehabilitation time compare to patients with low admission GV (27.5 ± 12.1 days vs. 31.7 ± 12.2 days; p=. 0.042). The high RI group (≥1. s/day) achieved significantly higher admission and discharge FIM scores (70.7 ± 15.9 vs. 64.1 ± 16.9, p=. 0.023; 87.3 ± 15.8 vs. 79.9 ± 17.4, p=. 0.013, respectively) and higher admission and discharge mFIM scores (45.3 ± 12.9 vs. 40.8.1 ± 12.7, p=. 0.049; 60.7 ± 12.4 vs. 56.2 ± 13.4, p=. 0.045, respectively) compared with the low performance group (<1. s/day). Logistic regression analyzed the variables with significant predictive value for achieving high RI (≥1. s/day): performance of the 6mWT at FIM ≥ 4 (OR 1.092; 95% CI, 1.056-1.129) and admission FIM score (OR 1.054; 95% CI, 1.023-1.085). Post-acute hip fracture patients capable of bearing weight on their injured leg, with minimal assistance [manual assistance of ≤25% (FIM ≥ 4)] may considerably improve their mobility regardless of their disability, cognitive level or neurological history. Most patients achieved GV enabling them to ambulate short distances within the home.