Abstract
Background: Predicting success of inpatient rehabilitation after hip fracture is an unmet challenge Objective: To assess whether a first impression Functional Independence Measure (FIM) before comprehensive evaluation may be useful to predict success in rehabilitation Setting: Geriatric rehabilitation center. Design: Retrospective observational study Subjects: 42 consecutive elderly patients with proximal hip fracture. Methods: The Functional Independence Measure (FIM) was assessed on the day of admission by a nurse (PreFIM), on day 3-5 by a multidisciplinary team (FimAdm) and on the day before discharge by the same multidisciplinary team (FIMDis). The potential of motor PreFIM to predict rehabilitation success, corresponding to motor FIMDis >58, was assessed, along with the length of stay in rehabilitation (LOS). Results: The mean motor PreFIM was 43.3 (SD 11.4), motor FIMAdm 48.9 (SD 13.7), motor FIMDis 63.8 (SD 16.7), LOS 22.5 days (SD 9.7). Motor PreFIM predicted motor FIM discharge >58, the surrogate measure for success of rehabilitation, with 76.7% sensitivity and 83.3% specificity. Motor PreFIM relation to LOS was statistically insignificant. Conclusions: In a population of disabled elderlies, the motor PreFIM on admission-day was helpful to predict success in rehabilitation after hip fracture, but not the necessary duration of rehabilitation. Large prospective studies are needed to validate this data.
Highlights
Numerous factors affect the outcomes of rehabilitation in patients with hip fractures, including age, sex, pre-fracture functional ability and frailty, cognitive status, affective status, patient motivation and preferences, comorbidity, the number of treatments, as well as family and social support [1,2,3,4,5]
The total Functional Independence Measure (FIM) improvement from admission to discharge was by 16.6 points (SD 9.9)
ROC curve analysis confronting length of stay in rehabilitation (LOS) with FIM Discharge >41 was insignificant statistically. In this cohort of elderly patients assigned for inpatient rehabilitation after hip fracture, the motor preliminary FIM (PreFIM) assessed by a nurse on admission day, proved to have 77% accuracy in predicting rehabilitation success, the latter corresponding to motor FIM discharge >58
Summary
Numerous factors affect the outcomes of rehabilitation in patients with hip fractures, including age, sex, pre-fracture functional ability and frailty, cognitive status, affective status, patient motivation and preferences, comorbidity, the number of treatments, as well as family and social support [1,2,3,4,5]. It would be important for clinicians to predict success of rehabilitation better than clinical judgment alone. The aim of the present study was to find an instrument, which is generally available, quick and easy to use, and might enhance the clinician’s judgment in defining situations when rehabilitation is futile. The candidate was the Functional Independence Measure (FIM) assessed on the admission-day by a nurse (PreFIM) before rehabilitation is started. Predicting success of inpatient rehabilitation after hip fracture is an unmet challenge
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