title: Proximal femur fracture in older patients--rehabilitation and clinical outcome.
abstract: BACKGROUND
  hip fracture is a major cause of morbidity and mortality in older people; optimal post-surgical treatment is a matter of controversy.
  
  
  OBJECTIVE
  to examine the effects of rehabilitation on the clinical outcome following surgical treatment of hip fracture.
  
  
  METHODS
  prospective longitudinal study in three groups of patients with different post-surgical care.
  
  
  METHODS
  initial screening of 283 elderly patients with proximal femur fracture; documentation of medical and social history and clinical data; geriatric assessments (Activities of Daily Living and Instrumental Activities of Daily Living) during hospital stay and follow-up for 12 months. One hundred and forty-five patients (>or=65 years) of normal mental status were eligible for the study. Successful follow-up could be monitored in 120 and 117 patients for 6 and 12 months, respectively. Sixty-nine and 39 patients underwent supervised inpatient rehabilitation in an orthopaedic or geriatric hospital, respectively (intervention groups A and B, respectively) whereas 34 patients received no special rehabilitation as they were directly discharged home (control group C).
  
  
  RESULTS
  initially a fall-/surgical-induced reduction (P<0.001) of the main outcome measure (Activities of Daily Living) was observed in all patients. Within 6 months of rehabilitation there was an improvement (P<0.01) in Activities of Daily Living; however the pre-fracture scores were not reached. The same time pattern was seen in group C. Therefore no significant differences between the three groups of patients in approaching the baseline status was visible. Moreover, the one-year total mortality in the studied population with normal mental status averaged 11.7% and did not differ between the three groups.
  
  
  CONCLUSIONS
  based on our measured outcome variables institutional rehabilitation after surgical treatment of hip fracture apparently had no significant impact on mortality and morbidity in older patients of normal mental status.
authors.affiliation: Department of Geriatric Rehabilitation, Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Röder
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwab
authors.forename: Thomas
authors.initials: T
authors.lastname: Aleker
authors.forename: Klaus
authors.initials: K
authors.lastname: Mörike
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Thon
authors.forename: Ulrich
authors.initials: U
authors.lastname: Klotz
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation*; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000534:rehabilitation; D011446:Prospective Studies; D011788:Quality of Life; D012047:Rehabilitation Centers; D015996:Survival Rate; D016896:Treatment Outcome