Objectives To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture. Design Longitudinal. Setting Inpatient rehabilitation units of two community hospitals. Participants Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133). Measurements Mini‐Mental State Examination ( MMSE ) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self‐Care Function and Functional Mobility) and the New Mobility Scale ( NMS ). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge. Results Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment ( PCRM ‐ CI ) intervention group had higher NMS scores after discharge than a usual care group. Conclusion Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.

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Currently, there are no standards for the development of posture classification systems used in observation-based ergonomic posture assessment methods. This study was conducted to determine if an optimal posture category size for different body segments and posture views could be established by examining the trade-off between magnitude of error and the number of posture category misclassification errors made. Three groups (trunk flexion/extension and lateral bend; shoulder flexion/extension and adduction/abduction; elbow flexion/extension) of 30 participants each selected postures they perceived to correctly represent the video image shown on a computer screen. For each view, 10 images were presented for five different posture category sizes, three times each. The optimal posture category sizes established were 30 degrees for trunk, shoulder and elbow flexion/extension, 30 degrees for shoulder adduction/abduction and 15 degrees for trunk lateral bend, suggesting that posture category size should be based on the body segment and view of the image being assessed. Across all conditions, the posture category sizes were comparable to those used in published ergonomic tools.

BackgroundA hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the health care system. Although inpatient rehabilitation programs have proven effective, the best practices for community-based rehabilitation required to maintain the gains in function and mobility post hospital discharge are currently unknown.ObjectiveThe aim of this systematic review is to identify and evaluate the evidence on the effectiveness of community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment (CI) following a hip fracture, and to identify the physical recovery outcomes and measures used in previous studies.MethodsThe methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy included a combination of text words and subject headings relating to the concepts of CI, dementia, delirium, cognitive reserve, and hip fractures. For a study to be included in the review, it had to involve participants with CI who underwent hip fracture surgery, and consisted of an outpatient intervention that occurred in the participant’s home or community. Peer-reviewed journal articles were identified by searching various databases. Two independent reviewers screened the titles and abstracts to determine which articles comprising of a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist were used during the full article data analysis and synthesis. A meta-analysis was not conducted due to heterogeneity of measures and outcomes.ResultsThe original search resulted in over 3000 articles. Of those, three studies satisfied the necessary criteria to be included in the systematic review. All studies included inpatient and outpatient physiotherapy, with some including a cognitive component, family education, and a discharge assessment.ConclusionsThe findings from this review suggest that community-based rehabilitation post hospital discharge interventions show promising results towards improving various physical function outcomes, mobility, and activities of daily living for older adults with CI following a hip fracture. This review also demonstrates and discusses the current lack of outpatient rehabilitation interventions targeted towards older adults with CI post-hip fracture. Additionally, several substantive gaps that require attention to move this field forward are highlighted.

The purpose of this study was to examine the influence of training on the decision times and errors associated with video-based trunk posture classifications. Altogether, 30 amateur and 30 knowledge-based participants completed a three-phase study (pre-training, training, post-training) that required them to classify static trunk postures in images on a computer screen into a posture category that represented the angle of the trunk depicted. Trunk postures were presented in both flexion/extension and lateral bend views and at several distances from the boundaries of the posture categories. Both decision time and errors decreased as distance from the boundaries increased. On average, amateur analysts experienced a larger decrease in decision time per posture classification than knowledge-based analysts (amateur: 0.79 s, knowledge-based: 0.60 s; p <0.05) suggesting that training can have beneficial effects on classification performance. The implications are that the analysis time associated with video-based posture assessment methods can be reduced with appropriate training, making this type of approach feasible for larger-scale field studies. Statement of Relevance:Understanding the role that training can play in reducing errors associated with the use of video-based posture assessment methods may result in more efficient use of these tools by ergonomic practitioners. Reducing decision time and misclassification errors will provide a more efficient, accurate and representative assessment of injury risk.