EFFECT OF ACUTE INPATIENT REHABILITATION ON OUTCOME AFTER FRACTURE OFTHE FEMORAL-NECK OR INTERTROCHANTERIC FRACTURE

A study was performed to assess the impact of intensive inpatient reha bilitation on the outcome after a fracture of the femoral neck or an i ntertrochanteric fracture, Before 1990, our hospital did not have an i npatient rehabilitation program, On January 1, 1990, a diagnosis-relat ed-group-exempt (DRG-exempt) acute rehabilitation program was initiate d, Patients were discharged to this program after evaluation by a staf f physiatrist, Before 1990, twenty-seven (9.0 per cent) of 301 patient s were discharged to an outside rehabilitation facility After January 1990, the percentage of patients who were discharged to the DRG-exempt program increased yearly from nineteen (17 per cent) of 113 patients in 1990 to forty-one (64 per cent) of sixty-four patients in 1993; thi s difference was significant (p < 0.01), Before 1990, the average dura tion of the stay in the hospital was 21.9 days, After January 1990, th e average duration for the patients who did not enter the rehabilitati on program was 20.0 days whereas the average duration for those who di d was 31.4 days (16.1 days for acute care and 15.6 days for the rehabi litation program), There were no differences in the hospital discharge status or in the walking ability, place of residence, need for home a ssistance, or independence in basic and instrumental activities of dai ly living at the six and twelve-month follow-up examinations between p atients who had been managed before initiation of the rehabilitation p rogram and those managed after it or between patients who had been dis charged to this program after its initiation and those who had not, Th ese results raise serious questions regarding the global cost-effectiv eness of these programs for patients who have had a fracture of the fe moral neck or an intertrochanteric fracture.