Effect of rehabilitation site on functional recovery after hip fracture.

OBJECTIVE

To evaluate whether FIM instrument motor outcomes differ between hip fracture survivors undergoing rehabilitation in inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs).

DESIGN

Inception cohort with follow-up to 12 weeks after hospital discharge.

SETTING

University-affiliated tertiary care hospital, IRFs, and SNFs.

PARTICIPANTS

All hip fracture patients prospectively admitted between March 1, 2002, and June 30, 2003, were eligible if they were 60 years or older and had surgical stabilization of the fracture.

INTERVENTIONS

Posthip fracture rehabilitation delivered at either IRFs or SNFs.

MAIN OUTCOME MEASURE

FIM motor score obtained postoperatively and at 2 and 12 weeks posthospital discharge.

RESULTS

IRF patients stayed an average of 12.8 days, whereas SNF patients averaged 36.2 days. Rehabilitation participation scores were obtained during therapy sessions and did not differ between groups. A repeated-measures analysis of covariance found a significant group by time interaction (F 2,68 =23.75, P <.001), which indicates that patients in an IRF had significantly higher FIM motor scores than those in an SNF across time. Logistic regression showed that IRF subjects were more likely to reach 95% of their prefracture FIM motor by week 12 than were SNF patients. A significantly higher percentage of IRF patients were discharged home after rehabilitation compared with SNF patients.

CONCLUSIONS

IRF patients had superior 12-week functional outcomes, as measured by the FIM motor score, compared with those treated in an SNF. The improved outcomes occurred during a significantly shorter rehabilitation length of stay and remained even when statistically controlling for baseline differences between groups. These data suggest that hip fracture survivors should not be excluded from receiving inpatient rehabilitation services. Randomized clinical trials are needed to understand more fully differences between rehabilitation treatment settings.