Functional Recovery in Hip Fracture Patients: a Real-practice Pilot Study Comparing Different Rehabilitation Settings

Abstract

Background: Hip fractures are a major source of disability in the elderly and rehabilitation is mandatory to recover pre-fracture functioning. To date, there is a big heterogeneity not only in terms of frequency and timing but also of choosing the most appropriate setting for hip fracture rehabilitation. In this real-practice pilot study we aimed at evaluating the long-term effects of rehabilitative intervention on disability status and functional outcomes in post-hip fracture elderly people.Methods: We included patients aged 65 years or older who had undergone surgical stabilization of a hip fracture. Exclusion criteria: pathological fractures or whose comorbidities could have an impact on motor, cognitive or sensory function. The sample was divided into 3 groups according to their destination after hospital discharge: Group 1, outpatient rehabilitation; Group 2, inpatient rehabilitation; Group 3, home-based rehabilitation. All three groups underwent a specific rehabilitation protocol for 3 times/week for 2 months. At the baseline (T0), at 3 months (T1), and at 6 months after fracture (T2), we assessed as outcome measures: Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, Medical Research Council scale (MRC) to assess muscle strength in hip flexion, hip abduction, and knee extension.Results: All three groups showed an average statistically significant improvement (p<0.05) in all the outcome measures compared to baseline, except for MRC of knee extension in group 3 at T1. Considering the between-group analysis, BI was significantly higher in Group 1 than in Group 2 at T2 (p=0.018).Conclusions: Taken together, our findings show that rehabilitation could lead to a significant improvement in functional recovery, independently from the settings, albeit outpatient rehabilitation seems to be the best option for hip fracture patients.