Pattern of functional change during rehabilitation of patients with hip fracture.
OBJECTIVE
To examine the rate of functional change in 2 domains, activities of daily living (ADLs) and mobility, over 2 time periods during hip fracture rehabilitation.


METHODS
Retrospective analysis of data contained in an administrative dataset.


METHODS
Seventy skilled nursing facilities (SNFs).


METHODS
People (N=351) receiving rehabilitation in SNFs from March 1998 to February 2003 after hip fractures.


METHODS
Not applicable.


METHODS
Rate of change in scores in the ADL and mobility domains of the FIM instrument during 2 time intervals of rehabilitation.


RESULTS
The rate of functional change across 2 time intervals was constant for mobility (mean change in FIM points per day, .46 vs .49), but declined in the second time period for ADLs (mean change in FIM points per day, .55 vs .41). Executive function, length of stay (LOS), and medical complexity were related to rate of change in mobility, and baseline ADLs, executive function, living setting, and LOS were related to rate of change in ADLs. There was an interaction between rehabilitation phase and baseline mobility. People with lower baseline mobility had an increased rate of change during the second interval (mean change in FIM points per day, .41 vs .55), whereas those with higher baseline mobility had a decreased rate of change (mean change in FIM points per day, .50 vs .43).


CONCLUSIONS
The pattern of functional change over time differed for ADL and mobility domains, and for specific groups of patients. The results have implications for goal setting and discharge planning.
Latham
Nancy K
NK
Health and Disability Research Institute, Boston University, Boston, MA 02215, USA. nlatham@bu.edu
Jette
Diane U
DU
Warren
Reg L
RL
Wirtalla
Christopher
C
D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods / Q000534:rehabilitation; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D051346:Mobility Limitation; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D018434:Sickness Impact Profile; D012866:Skilled Nursing Facilities; D016896:Treatment Outcome