Alison M. Cogan
Rate of recovery and length of stay in skilled nursing facilities and inpatient rehabilitation facilities correlated with mobility and self-care results at discharge in patients who underwent hip fracture surgery, according to study results.
“Some patients may be better served by having more time in rehab to recover and a less intensive therapy regimen after surgery for hip fracture,” Alison M. Cogan, PhD, OTR/L, told Healio Orthopedics. “We have more work to do to identify the patients who are most likely to benefit from more intensive therapy and if specific interventions are associated with the best outcomes.”
Researchers retrospectively evaluated 150 patients aged 65 years or older who received rehabilitation services for hip fractures from four inpatient facilities and seven skilled nursing facilities. Investigators noted patients had Medicare fee-for-service as the primary payer. At discharge, the functional independence measure mobility and self-care outcome measures were assessed. Based on low, medium or high therapy minutes per length of stay day and low, medium or high rate of functional gain per day, investigators categorized patients into nine recovery groups.
Results showed similar function at rehabilitation admission among patients in all gain and therapy minutes per length of stay day trajectories. However, patient groups were significantly different at discharge. Investigators noted mobility independence was achieved by high-gain patients by discharge, while low-gain patients needed help on almost all mobility tasks. At discharge, medium-gain patients with a mean length of stay of 27 days achieved mobility independence while those with a mean length of stay of less than 21 days required supervision with toilet transfers and needed assistance with stairs.
Recovery and length of stay in skilled nursing facilities and inpatient rehab facilities associated with mobility and self-care results in patients who underwent hip fracture surgery.
“Length of stay and functional gain rate explained much of the variance in mobility and self-care scores at discharge,” the authors wrote. “Although medium- and high- therapy minutes per [length of stay] LOS day groups were statistically significant in the regression model (=6.99; P=.001; and =11.46; P=.007, respectively), they explained only 1% of the variance in discharge outcome. Marginal means suggest that medium-gain patients with shorter LOS would have achieved mobility independence if LOS had been extended.” – by Monica Jaramillo
Disclosure: Cogan reports she receives support from a polytrauma/TBI advanced fellowship funded by the Veterans Health Affairs Office of Academic Affiliations.