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Pattern of functional change during rehabilitation of patients with hip fracture
Nancy K Latham1, Diane U Jette, Reg L Warren
1Health and Disability Research Institute, Boston University, Boston, MA 02215, USA. nlatham@bu.edu
Objective:
To examine the rate of functional change in 2 domains, activities of daily living (ADLs) and mobility, over 2 time periods during hip fracture rehabilitation.
Design:
Retrospective analysis of data contained in an administrative dataset.
Setting:
Seventy skilled nursing facilities (SNFs).
Participants:
People (N=351) receiving rehabilitation in SNFs from March 1998 to February 2003 after hip fractures.
Interventions:
Not applicable.
Main Outcome Measure:
Rate of change in scores in the ADL and mobility domains of the FIM instrument during 2 time intervals of rehabilitation.
Results:
The rate of functional change across 2 time intervals was constant for mobility (mean change in FIM points per day, .46 vs .49), but declined in the second time period for ADLs (mean change in FIM points per day, .55 vs .41). Executive function, length of stay (LOS), and medical complexity were related to rate of change in mobility, and baseline ADLs, executive function, living setting, and LOS were related to rate of change in ADLs. There was an interaction between rehabilitation phase and baseline mobility. People with lower baseline mobility had an increased rate of change during the second interval (mean change in FIM points per day, .41 vs .55), whereas those with higher baseline mobility had a decreased rate of change (mean change in FIM points per day, .50 vs .43).
Conclusions:
The pattern of functional change over time differed for ADL and mobility domains, and for specific groups of patients. The results have implications for goal setting and discharge planning.
