title: Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients.
abstract: OBJECTIVE
  To examine effects of physical and geriatric rehabilitation on institutionalisation and mortality after hip fracture.
  
  
  METHODS
  Prospective randomised study.
  
  
  METHODS
  Physically oriented (187 patients), geriatrically oriented (171 patients), and health centre hospital rehabilitation (180 patients, control group).
  
  
  METHODS
  A total of 538 consecutively, independently living patients with non-pathological hip fracture.
  
  
  METHODS
  Patients were evaluated on admission, at 4 and 12 months for social status, residential status, walking ability, use of walking aids, pain in the hip, activities of daily living (ADL) and mortality.
  
  
  RESULTS
  Mortality was significantly lower at 4 and 12 months in physical rehabilitation (3.2%, 8.6%) than in geriatric rehabilitation group (9.6%, 18.7%, P=0.026, P=0.005, respectively) or control group (10.6%, 19.4%, P=0.006, P=0.004, respectively). At 4 months more patients in physical (84.4%) and geriatric rehabilitation group (78.0%) were able to live at home or sheltered housing than in control group (71.9%, P=0.0012 and P<0.001, respectively). No significant difference was found between physical rehabilitation and geriatric rehabilitation (P=0.278). Analysis of femoral neck and trochanteric fractures showed that significant difference was true only for femoral neck fractures (physical rehabilitation vs geriatric rehabilitation P=0.308, physical rehabilitation vs control group P<0,001 and geriatric rehabilitation vs control group P<0.001). Effects of intensified rehabilitations disappeared at 12 months. No impact on walking ability or ADL functions was observed.
  
  
  CONCLUSIONS
  Physical rehabilitation reduced mortality. Physical and geriatric rehabilitation significantly improved the ability of independent living after 4 months especially among the femoral neck fracture patients but this effect could not be seen after 12 months.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Lahtinen
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Juhana
authors.initials: J
authors.lastname: Leppilahti
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Samppa
authors.initials: S
authors.lastname: Harmainen
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Sipilä
authors.affiliation: Health Center Hospital of Oulu, Oulu University Hospital, Oulu, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Antikainen
authors.affiliation: Health Center Hospital of Oulu, Oulu University Hospital, Oulu, Finland.
authors.forename: Maija-Liisa
authors.initials: ML
authors.lastname: Seppänen
authors.affiliation: Central Hospital of Länsi-Pohja, Kemi, Oulu University Hospital, Oulu, Finland.
authors.forename: Reeta
authors.initials: R
authors.lastname: Willig
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Vähänikkilä
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Ristiniemi
authors.affiliation: Department of Economics, University of Tampere, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Rissanen
authors.affiliation: Department of Orthopedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland pekka.jalovaara@oulu.fi.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jalovaara
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005387:Finland; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D057187:Independent Living; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: Hip fracture; clinical outcome; rehabilitation