Multidisciplinary inpatient rehabilitation improves the long-term functional status of geriatric hip-fracture patients

Abstract

Background: As the world population ages, the number of hip-related fractures in the elderly is steadily increasing. These fractures generate a major worldwide healthcare problem and frequently lead to deterioration of life quality, mobility and independence in activity of daily life of geriatric patients. At present, many studies have investigated and proved benefits of multidisciplinary orthogeriatric care for elderly hip-fracture patients. Only few studies however, have analyzed treatment concepts for those patients directly following discharge from hospital in specialized rehabilitation centers. The aim of this study was to evaluate effects of a multidisciplinary inpatient rehabilitation on the shortand long-term functional status of geriatric patients who suffered from hip fracture. Methods: A total of 161 hip-fracture patients aged 80 years and above, or additionally 70 years and above suffering from age-typical multimorbidity were included in this study. Patients who had an initial Barthel Index lower than 30 points were excluded from this study, as most of these patients were not able to attend a therapy at the rehabilitation center due to a poor functional status. The patients were separated into two subgroups dependent on the availability of treatment spots at the rehabilitation center. No other item was used to discriminate between the groups. Group A (n = 95) stayed an average of 21 days at an inpatient rehabilitation center that specialized in geriatric patients. Group B (n = 66) underwent the standard postoperative treatment and were sent home with further treatment by their general practitioner, nursing staff and physiotherapists. To evaluate the patients' functional status over the course of time we used the Barthel Index, which was evaluated for every patient on the day of discharge, as well as during checkups after 3, 6 and 12 months. Results: The average Barthel Index at the day of discharge was 57.79 ± 14.92 points for Group A and 56.82 ± 18.76 points for Group B (p = 0.431). After 3 months, the average Barthel Index was 82.43 points for Group A and 73.11 points for group B (p = 0.005). In the 6-month checkup Group A's average Barthel Index was 83.95 points and Group B's was 74.02 points (p = 0.002). After 12 months, patients from Group A had an average Barthel Index of 81.21 while patients from Group B had an average Barthel Index of 69.85 (p = 0.005). Conclusion: The results of this study reveal a significantly better outcome concerning both, short-term and longterm functional status after 3, 6 and 12 months for geriatric hip-fracture patients, who underwent an inpatient treatment in a rehabilitation center following the initial therapy.

Hip arthroplasty for unstable femoral trochanteric fractures using the direct anterior approach

“…In this study, we measured the Barthel Index, which quanti es functional evaluation of the activities of daily living of the elderly. The validity and reliability of the Barthel Index have been veri ed, and it is widely used in studies on outcomes of orthopedic diseases [17][18][19]. The present study clari ed that functional recovery was more favorable in the arthroplasty group than in the osteosynthesis group.…”

Orthogeriatric co-management: differences in outcome between major and minor fractures

“…Gosch et al describe significant increases in BI for their long-term care residents independent of fracture from day 5 to a 3 month follow-up [ 7 ]. Another study supports these findings, reporting an average increase of BI from discharge to 1 year follow-up of 23.42 points (hip fracture patients that underwent inpatient rehabilitation after acute treatment) or 13.03 points (hip fracture patients that did not undergo inpatient rehabilitation after acute treatment), further underlining the importance of inpatient rehabilitation to ameliorate ADL in the long term [ 19 ].…”

Long-term health-related quality of life and independence among older survivors of serious injury

“…13 Notably, geriatrics consultations were not linked to frailty assessment and the study population was not limited to patients requiring TICU care, suggesting that older trauma patients without TICU needs or frailty may obtain long-term benefit from CGA. This prior work, as well as studies of inpatient geriatrics assessment among older adults hospitalized for hip fracture 32 or medical illness 33 support that hospital-based interventions do have potential to influence long-term functional outcomes. Notably, most similar prior studies of geriatric trauma care pathways have not described preinjury functional independence among participants.…”