Abstract
Background: As the population ages, the rate of hip fractures and the need for rehabilitation increases. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks.Methods: A retrospective study of patients 65 years and above following surgery to repair a hip fracture who underwent HBR or IR between 2016 and 2019. The two rehabilitation frameworks were compared for rehabilitation outcome and factors predicting successful rehabilitation. The outcome was determined with the Montebello Rehabilitation Factor Score-Revised (MRFS-R).Results: Data were collected for 235 patients over 3 years. The mean age was 81.3 ± 8.0 and 172 (73.3%) were women. Of these, 138 underwent IR and 97 HBR. The HBR group had better family support and fewer lived alone. There were also differences in the type of fracture and surgery. The medical condition of the IR group was more complex, as reflected in a higher Charlson's comorbidity scores, higher rates for delirium and more infectious complications, a lower Norton score, lower serum hemoglobin, and albumin levels, and higher serum creatinine and urea levels. It also had a more significant functional decline after surgery and required a longer rehabilitation period. However, no difference was found in the rehabilitation outcomes between the two groups (MRFS-R ≥ 50). The independent predictors for rehabilitation in the IR group were serum albumin level, comorbidity, and cognitive state. There were no independent predictors in the HBR group.Conclusions: In this retrospective study, there was no significant difference in short-term rehabilitation outcomes between the HBR and IR groups event though the patients in the IR group were medically more complex. This result should be taken into account when planning rehabilitation services after hip fracture and tailoring rehabilitation frameworks to patients.
Highlights
Hip fracture, a common problem in elderly patient populations, is associated with functional impairment, reduced quality of life, and even mortality [1]
Two systematic reviews were published recently [8, 9] that evaluated the effectiveness of home-based rehabilitation (HBR) for patients with fractures of the femoral neck, but most studies included in the review related to ongoing rehabilitation processes and not intensive rehabilitation immediately after surgery
The inpatient rehabilitation (IR) group had fewer married patients (56.7 vs. 33.3%, P = 0.001), more patients who lived alone (41.3 vs. 10.0%, P < 0.001), and fewer patients with a partner who played the role of main caregiver (41.2 vs. 32.6%, P = 0.008)
Summary
A common problem in elderly patient populations, is associated with functional impairment, reduced quality of life, and even mortality [1]. In a latest systematic review of the literature and meta-analysis [2], the investigators found that compared to conventional care rehabilitation by a multidisciplinary team improves functional condition and motility. Two systematic reviews were published recently [8, 9] that evaluated the effectiveness of HBR for patients with fractures of the femoral neck, but most studies included in the review related to ongoing rehabilitation processes and not intensive rehabilitation immediately after surgery. In an analysis of administrative databases with a propensitymatched cohort of over 18,000 patients after a femoral neck fracture who were discharged to non-institutional rehabilitation in the community including HBR, the cost of community-based treatment including HBR was lower, but rehospitalization and mortality rates were higher [16]. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks
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