title: Regaining functional independence in the acute care setting following hip fracture.
abstract: OBJECTIVE
  Factors that predict functional recovery in the first few days following hip fracture and that may facilitate discharge to the home directly from the acute care setting have not been identified. This study investigated the attainment of key functional milestones by patients and discharge status from an acute care hospital following hip fracture.
  
  
  METHODS
  Subjects were 162 community-based individuals (59 men, 103 women) aged 60 years or older who were admitted to an acute care hospital following unilateral hip fracture.
  
  
  METHODS
  Data on personal, medical surgical, hospital course, and acute rehabilitation factors as well as functional status and placement at the time of discharge were collected. Adjusted odds ratios were calculated to determine predictors of independence in seven types of transfers and ambulation activities and discharge directly to the home.
  
  
  RESULTS
  Subjects who ambulated independently prior to fracture, stayed longer in the acute care setting, and received physical therapy on average more than once a day had improved odds of regaining independence in bed mobility, transfers, and ambulation. Subjects who regained independence and received physical therapy on average more than once a day had improved odds of discharge directly to the home from the acute care setting. Increasing age and postoperative complications reduced the odds of discharge directly home.
  
  
  CONCLUSIONS
  A substantial proportion of patients with hip fracture achieve independence in bed mobility and transfers and in ambulation with a walker during the early postoperative phase, although few progress to a higher level during a short-term stay in the acute care setting. Frequency of physical therapy, among other factors, appears to improve the odds of regaining functional independence and discharge directly to the home from the acute care setting.
authors.affiliation: Department of Orthopaedics, Harvard Medical School, Boston, MA, USA. guccionea@al.mgh.harvard.edu
authors.forename: A A
authors.initials: AA
authors.lastname: Guccione
authors.forename: T L
authors.initials: TL
authors.lastname: Fagerson
authors.forename: J J
authors.initials: JJ
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D026741:Physical Therapy Modalities; D011379:Prognosis; D011446:Prospective Studies