title: Determinants of outcome in hip fracture: role of daily living activities.
abstract: BACKGROUND
  Very few studies have investigated activities of daily living (ADLs) post hip-surgery as a possible determinant of functional outcome after hip fracture.
  
  
  OBJECTIVE
  This prospective, observational study aimed to correlate hip-fracture patients' ADLs on admission to in-hospital rehabilitation with their functional outcome post-rehabilitation.
  
  
  METHODS
  Of 216 consecutive hip-fracture patients admitted to our Rehabilitation Unit, 204 patients were eligible for the final analyses. All patients underwent the usual rehabilitation. At admission, basic ADLs were assessed by the Functional Independence Measure (FIM) scale. Discharge scores, efficiency and effectiveness in motor-FIM, and discharge destination were outcome measures. Backward stepwise regressions were performed to identify determinants of outcome measures. Age, sex, education, number of relatives, orthopedic treatment, onset to admission interval, Mini Mental State Examination (MMSE), Cumulative Illness Rating Scale, Neuropsychiatric Inventory, ROM, Muscle Strength, and FIM scores at admission were independent variables.
  
  
  RESULTS
  There was functional gain in all ADLs post-rehabilitation, walking being the FIM-item with the highest efficiency and effectiveness (respectively, 0.14±0.0 and 64.2±21). Multivariate analyses showed that MMSE was a determinant of final score, efficiency, and effectiveness in motor-FIM. Bladder control was a determinant of final score and effectiveness in motor-FIM, while eating and bathing were determinants of final motor-FIM score. Bowel management was the only determinant of discharge destination.
  
  
  CONCLUSIONS
  Basic ADLs, in particular eating, bathing, bladder and bowel management, are important determinants of outcome in hip fracture.
  
  
  CONCLUSIONS
  The results of this study suggest that, in designing studies on outcome prediction in hip fracture, researchers should include tests assessing performance of basic ADLs as independent variables, as this could allow to identify new prognostic indicators that may be helpful for physicians in managing hip fracture patients post-rehabilitation.
authors.affiliation: Unit of Recovery and Functional Rehabilitation, Scientific Institute of Lumezzane, Fondazione Salvatore Maugeri IRCCS, Lumezzane, Brescia, Italy - bernardo.gialanella@fsm.it.
authors.forename: B
authors.initials: B
authors.lastname: Gialanella
authors.forename: C
authors.initials: C
authors.lastname: Ferlucci
authors.forename: V
authors.initials: V
authors.lastname: Monguzzi
authors.forename: P
authors.initials: P
authors.lastname: Prometti
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000503:physiopathology / Q000534:rehabilitation*; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D016896:Treatment Outcome