Outcomes and weight-bearing status during rehabilitation after arthroplasty for hip fractures.
OBJECTIVE
To examine the association of weight-bearing status with patient-related variables and outcomes of inpatient rehabilitation after hip arthroplasty for acute hip fracture.


METHODS
A multi-site prospective observational cohort study.


METHODS
Eighteen skilled nursing and inpatient rehabilitation facilities.


METHODS
Patients with hip fractures (N = 224) treated with hip arthroplasty and admitted to either skilled nursing or inpatient rehabilitation facilities; a subset (N = 84) with telephone follow-up outcomes 8 months after rehabilitation discharge.


METHODS
Measurements included demographic variables, medical severity using the Comprehensive Severity Index, and functional levels using the Functional Independence Measure. MAIN OUTCOMES MEASUREMENT: Cognitive, motor, and total Functional Independence Measure scores at rehabilitation discharge and at 8-month follow-up; living location at discharge and follow-up.


RESULTS
Patients on average (standard deviation) were 76.8 ± 11.4 years old, mainly women (78%), and mainly white (87%). In unadjusted analysis, weight bearing as tolerated (WBAT) was associated with less osteoarthritis (P = .025) and lower admission medical severity (ACSI) (P = .014). One participating facility had a significant preponderance of restricted weight-bearing cases. WBAT had no bivariate association with cognitive or motor function at discharge. Therapists cited restricted weight bearing as a barrier to therapy in 11% of cases. In logistic regressions, lower medical admission severity, older age, and one specified site significantly predicted WBAT (c statistic = 0.714). Significant predictors for home discharge included lower maximum severity (P < .001), younger age (P < .001), higher cognition (P = .037), and WBAT (P = .051) (c statistic = 0.863).


CONCLUSIONS
WBAT is associated with a greater likelihood of home discharge and had similar functional outcomes compared with restricted weight bearing. These findings add support for allowing WBAT after arthroplasty for hip fracture.
Siebens Patient Care Communications, 13601 Del Monte Dr., Seal Beach, CA 90740, USA. info@siebenspcc.com
Hilary C
HC
Siebens
Phoebe
P
Sharkey
Harriet U
HU
Aronow
Susan D
SD
Horn
Michael C
MC
Munin
Gerben
G
DeJong
Randall J
RJ
Smout
Craig S
CS
Radnay
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015207:Osteoarthritis, Hip / Q000175:diagnosis; D010024:Osteoporosis / Q000175:diagnosis; D010351:Patient Discharge / Q000706:statistics & numerical data; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D016896:Treatment Outcome; D016474:Weight-Bearing