Outcomes and weight-bearing status during rehabilitation after arthroplasty for hip fractures.
Outcomes and weight-bearing status during rehabilitation after arthroplasty for hip fractures.
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. Copyright 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved. DESIGN: A multi-site prospective observational cohort study. 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. 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. 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). SETTING: Eighteen skilled nursing and inpatient rehabilitation facilities. SUBJECTS: 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.
English
1934-1482
*Arthroplasty, Replacement, Hip/rh [Rehabilitation]
*Hip Fractures/su [Surgery]
*Weight-Bearing
Aged
Chi-Square Distribution
Cognition Disorders/di [Diagnosis]
Female
Humans
Logistic Models
Male
Osteoarthritis, Hip/di [Diagnosis]
Osteoporosis/di [Diagnosis]
Patient Discharge/sn [Statistics & Numerical Data]
Recovery of Function
Rehabilitation Centers
Severity of Illness Index
Skilled Nursing Facilities
Treatment Outcome
MedStar National Rehabilitation Network
Journal Article
Research Support, Non-U.S. Gov't
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. Copyright 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved. DESIGN: A multi-site prospective observational cohort study. 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. 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. 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). SETTING: Eighteen skilled nursing and inpatient rehabilitation facilities. SUBJECTS: 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.
English
1934-1482
*Arthroplasty, Replacement, Hip/rh [Rehabilitation]
*Hip Fractures/su [Surgery]
*Weight-Bearing
Aged
Chi-Square Distribution
Cognition Disorders/di [Diagnosis]
Female
Humans
Logistic Models
Male
Osteoarthritis, Hip/di [Diagnosis]
Osteoporosis/di [Diagnosis]
Patient Discharge/sn [Statistics & Numerical Data]
Recovery of Function
Rehabilitation Centers
Severity of Illness Index
Skilled Nursing Facilities
Treatment Outcome
MedStar National Rehabilitation Network
Journal Article
Research Support, Non-U.S. Gov't