title: Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.
abstract: Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.
  
  
  OBJECTIVE
  To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.
  
  
  METHODS
  Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Walking ability and ADLs index at 4-month and 12-month follow-up.
  
  
  RESULTS
  Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44-19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8-3.5; P<.001), while type of surgery was not (P=.376).
  
  
  CONCLUSIONS
  Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.
authors.affiliation: Institute of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopaedics, Karolinska University Hospital, Huddinge, Sweden. amer.al-ani@karolinska.se
authors.forename: Amer N
authors.initials: AN
authors.lastname: Al-Ani
authors.forename: Lena
authors.initials: L
authors.lastname: Flodin
authors.forename: Anita
authors.initials: A
authors.lastname: Söderqvist
authors.forename: Paul
authors.initials: P
authors.lastname: Ackermann
authors.forename: Eva
authors.initials: E
authors.lastname: Samnegård
authors.forename: Nils
authors.initials: N
authors.lastname: Dalén
authors.forename: Maria
authors.initials: M
authors.lastname: Sääf
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.forename: Margareta
authors.initials: M
authors.lastname: Hedström
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012047:Rehabilitation Centers; D016138:Walking