title: Measuring rehabilitation outcome in post-acute hip fractured patients.
abstract: OBJECTIVE
  To present our experience in measuring rehabilitation achievements of post-acute hip fractured patients with the FIM instrument; assess its appropriateness as to the patients' various disability levels and describe our experience with other measuring tools in patients less sensitive to changes in the FIM instrument.
  
  
  METHODS
  A retrospective study performed in a post-acute geriatric rehabilitation center. Three hundred and eighty-seven hip fractured patients admitted from January 2010 to May 2012 were included in this study. Patients were evaluated by the Functional Independence Measure (FIM), the Timed Get Up and Go (TUG) test and "bed to chair" transfer FIM parameter. The study population was divided into three disability groups according to their admission disability level: high (admission FIM score <40), moderate (FIM 40-79) and low (FIM ≥ 80). The Mann-Whitney U, ANOVA and Chi square tests analyzed the data.
  
  
  RESULTS
  The FIM instrument was found most sensitive in identifying functional change in patients with moderate disability. Low disability patients received more physio- and occupational-therapy treatment time, yet achieved a lower mean FIM score change compared to moderately disabled patients. The smallest real difference (SRD = 13) for the FIM score was achieved by 60% of patients with moderate disability. When assessed by the TUG test, most patients (94%) improved their score. The SRD% of 31% was achieved by 71.7% of the patients. Nineteen patients (35.9%) achieved a discharge score of <20 s. The high disability group achieved the lowest mean FIM score change. On admission, 52/64 (81%) patients required considerable help in transferring from bed to chair (FIM 1-2), however, upon discharge, the majority (69.2%) improved to the level of a one man transfer (FIM ≥ 3). Forty-one (64.1%) patients were discharged home.
  
  
  CONCLUSIONS
  Post-acute hip fracture patients exhibit variable functional ability. Assessing rehabilitation achievements with a disability measure is limited; therefore, it is advisable to use an instrument most suitable to the patients' disability level.
authors.affiliation: Geriatric Rehabilitation Ward, "Beit Rivka" Geriatric Rehabilitation Center , Petach Tikva , Israel and.
authors.forename: Avital
authors.initials: A
authors.lastname: Hershkovitz
authors.forename: Riki
authors.initials: R
authors.lastname: Brown
authors.forename: Arie
authors.initials: A
authors.lastname: Burstin
authors.forename: Shai
authors.initials: S
authors.lastname: Brill
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hip fracture; older people; outcome measures; rehabilitation