Evaluation of clinical prognosis and activities of daily living using functional independence measure in patients with hip fractures.
BACKGROUND
The functional independence measure (FIM) is an evaluation method of activities of daily living (ADL) that assesses motor functions and cognitive functions in the Uniform Data System. The FIM has recently been used to assess disability. The purpose of this study was to standardize criteria using the FIM for determining when and to where patients can be discharged following surgery for hip fracture.


METHODS
Patients with hip fracture (n=68) aged>or=65 years who underwent surgery at our hospital were classified by their residence at the time of injury (their own home, a hospital, or an elderly care facility) and by postoperative residence after discharge from hospital. We investigated the FIM of these patients before injury and at the time of discharge and retrospectively compared the results with the Japan Orthopaedic Association (JOA) hip score at the time of discharge.


RESULTS
Patients who entered a facility after discharge following surgery demonstrated a reduction in motor function score on the FIM. Cognitive function scores in each group were not reduced postoperatively in the short term. The average reduction in scores on the FIM for patients who were discharged from hospital to their own home was 15.9 points, and it was 25.9 points for those who were injured in their own home and transferred to a facility after discharge. There was a significant correlation between the FIM and the JOA hip score at the time of discharge.


CONCLUSIONS
The FIM cannot determine whether such patients should be discharged to their home or transferred to a care facility. However, the motor function scores on the FIM are valid for assessing hip fracture patients and may be suitable as a standardized procedure for determining their postdischarge residence.
Takeda
Haruhiko
H
Department of Orthopaedic Surgery, Ehime University School of Medicine, Shitsukawa, Toon, and Ishikawa Hospital, Ehime, 791-0295, Japan.
Kamogawa
Junji
J
Sakayama
Kenshi
K
Kamada
Kazuo
K
Tanaka
Shinji
S
Yamamoto
Haruyasu
H
D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D010351:Patient Discharge / Q000592:standards*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index