Rehabilitation outcomes in patients with full weight-bearing hip fractures

Evaluation of the functional outcome for hip fractured elderly patients has been controversial due to a typical casemix containing both weight bearing and non weight bearing postoperative fractures. The purpose of this study was to investigate factors associated with rehabilitation outcomes in patie nts who are able to fully weight bearing following surgical repair of femor al neck fracture. We studied 217 consecutive patients admitted for rehabili tation after surgery for hip fracture. Age, gender, marital status, type of fracture and admission Functional Independence Measure (FIM) were evaluate d as possible predictors of rehabilitation outcome. Functional gains were e valuated according to FIM. Dependent outcome variables were calculated as a bsolute (total FIM gain and daily FIM gain) as well as relative (to potenti al). Results showed a significant improvement in absolute total and daily F IM gains (19.32 +/- 8.29, and 0.87 +/- 0.44, respectively). Relative total functional gain was 0.40 +/- 0.19. Absolute total functional gain did not d epend on FIM admission, whereas all other parameters were significantly cor related with FIM scores on admission, indicating a relatively adverse rehab ilitation in patients with an admission FIM of 40 points or lower. The majo rity (83.9%) of patients were discharged home. A significant association ex ists between the ability to go home and marital status (P = 0.009), as well as with admission FIM (P < 0.0001). We conclude that encouraging outcome r esults are achieved in the elderly with full weight bearing fractures. The absolute functional gains do not depend on FIM admission scores and argues for inclusion of patients with low admission FIM scores to rehabilitation p rograms. However, the relative gains are significantly better in patients w ith higher admission FIM scores, thus supporting inclusion of selected pati ents. This poses serious ethical issues for healthcare policy-makers. (C) 2 001 Elsevier Science Ireland Ltd. All rights reserved.