MedStar Authors catalog › Details for: Initial recovery trajectories among patients with hip fracture: a conceptual approach to exploring comparative effectiveness in postacute care.
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Initial recovery trajectories among patients with hip fracture: a conceptual approach to exploring comparative effectiveness in postacute care.

by DeJong, Gerben.
Citation: Pm & R. 4(4):264-72, 2012 Apr..Journal: PM & R : the journal of injury, function, and rehabilitation.ISSN: 1934-1482.Full author list: Aronow HU; Sharkey P; Siebens HC; Horn SD; Smout RJ; DeJong G; Munin MC; Radnay CS.UI/PMID: 22244336.Subject(s): Aged | Aged, 80 and over | Arthroplasty, Replacement, Hip/rh [Rehabilitation] | Female | Follow-Up Studies | Hip Fractures/pp [Physiopathology] | *Hip Fractures/rh [Rehabilitation] | Hip Fractures/su [Surgery] | *Hip Joint/ph [Physiology] | Humans | Length of Stay/td [Trends] | Male | Patient Discharge/td [Trends] | Prospective Studies | *Recovery of Function | *Rehabilitation Centers/sn [Statistics & Numerical Data] | Reproducibility of Results | *Skilled Nursing Facilities/sn [Statistics & Numerical Data] | Treatment OutcomeInstitution(s): MedStar National Rehabilitation NetworkActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Multicenter Study | Research Support, Non-U.S. Gov'tAbbreviated citation: PM R. 4(4):264-72, 2012 Apr.Abstract: OBJECTIVE: To assess whether clusters of patients with hip fracture and with distinct initial recovery trajectories (IRT) could be identified by using practice-based evidence data and to examine the validity of these data.Abstract: DESIGN: Analysis of multisite prospective observational cohort study database.Abstract: SETTING: Eighteen skilled nursing and inpatient rehabilitation facilities.Abstract: PATIENTS: Patients with hip fractures (N = 226) treated with joint replacement and admitted to skilled nursing or inpatient rehabilitation facilities, subset (n = 85), with telephone follow-up results approximately 8 months after rehabilitation discharge. Patients' ages were 76.8 +/- 11.4 years; the majority were women (78%) and white (87%).Abstract: METHODS: Measurements included medical severity by using the Comprehensive Severity Index and functional levels by using Functional Independence Measure (FIM). The IRT was calculated for each patient as the rate of 130912 in function from the time of surgery to rehabilitation admission. We used cluster analysis to partition patients into subsets that shared common IRT scores. Validity was explored by comparing subgroups across patient characteristics and treatment patterns. Significance was defined as P <= .05.Abstract: MAIN OUTCOMES MEASUREMENTS: IRT grouping, Comprehensive Severity Index, FIM, discharge location, living location at follow-up.Abstract: RESULTS: We identified 3 patient clusters with differentiated IRT scores: group 1: 4.96 +/- 2.45 (range, 0.4-8.6) FIM point 130912 per day; group 2: 12.42 +/- 2.51 (range, 8.9-17.0); group 3: 26.80 +/- 13.78 (range, 17.5-70.0). Clinical group validation was established from statistically different Comprehensive Severity Index scores on admission; FIM scores at admission, discharge, and follow-up; and discharge and 8-month living settings. Calculation of IRT recovery curves by using FIM scores and associated time in days through logarithmic regression curves confirmed each group's IRT remained distinct through rehabilitation and follow-up.Abstract: CONCLUSIONS: The IRT concept appears to be valid in patients with hip fracture who were treated with hip arthroplasty, and may assist in evaluating and comparing the effectiveness of postacute rehabilitation services. Copyright 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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