Influence of rehabilitation site on hip fracture recovery in community-dwelling subjects at 6-month follow-up.
OBJECTIVE
To evaluate whether postacute rehabilitation after hip fracture influences recovery of prefracture function as detected by the FIM instrument motor scale.


METHODS
Inception cohort.


METHODS
University-affiliated tertiary care hospital; inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs).


METHODS
People with acute proximal femur fracture treated between March 1, 2002, and June 30, 2003.


METHODS
Post-hip fracture rehabilitation delivered at an IRF or SNF.


METHODS
FIM motor score estimated prefracture and obtained at 2 weeks and 24 weeks after hospital discharge.


RESULTS
Fifty-eight patients were treated at an IRF, whereas 39 were treated at an SNF. Controlling for baseline covariates, a mixed model showed a significant group by time interaction (F(3,57.1)=14.27, P < .001). Contrasts indicated that IRF subjects had greater initial improvement. Multiple logistic regression examining factors associated with recovery of FIM motor score to 95% or more of prefracture FIM motor score by 24 weeks found that IRF setting only was associated with recovery of baseline function with odds ratio of 5.44 (95% confidence interval, 2.02-14.65).


CONCLUSIONS
Even when controlling for important baseline covariates, community-dwelling hip fracture subjects treated in an IRF are more likely to attain 95% or more of prefracture functional status by 24 weeks postdischarge than subjects treated in an SNF.
Munin
Michael C
MC
Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. muninmc@upmc.edu
Begley
Amy
A
Skidmore
Elizabeth R
ER
Lenze
Eric J
EJ
D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome