Hershkovitz Avital, Kalandariov Zulicha, Hermush Vered, Weiss Roni, Brill Shai
Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel.
Arch Phys Med Rehabil. 2007 Jul;88(7):916-21. doi: 10.1016/j.apmr.2007.03.029.
To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture.
Geriatric rehabilitation center.
One hundred thirty-three older patients.
Not applicable.
FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS).
Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home.
Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.
确定与老年近端髋部骨折残疾患者急性后期康复结局相关的因素。
老年康复中心。
133名老年患者。
不适用。
功能独立性测量工具（FIM）、运动FIM评分、FIM及运动FIM评分的绝对功能改善、FIM及运动FIM评分的相对功能改善、FIM及运动FIM评分的改善率、出院回家患者的比例以及住院时间（LOS）。
FIM平均评分提高了14分（22%），功能改善率为每天0.56分。在上述结局指标方面，负重和非负重患者之间未发现显著差异（P>0.05）。功能独立且认知完整的患者在评分变化和改善率方面显著更好，并且比依赖和认知受损的患者表现出更高的挖掘其康复潜力的能力。他们的住院时间显著更短。骨折至手术的延迟时间超过5天的患者和有中风病史的患者住院时间显著更长。简易精神状态检查表评分、入院时白蛋白水平以及骨折前功能状态是与FIM出院评分（r = 0.756）和FIM相对功能改善（r = 0.583）相关的最重要参数。抑郁是入院时有负重指示的患者住院时间的最重要相关因素。有照料者是回家的显著预测价值变量。
认知功能、营养状况、伤前功能水平和抑郁是与老年近端髋部骨折患者康复成功相关的最重要预后因素。其中，抑郁和营养状况是可纠正的，早期干预可能改善康复结局。
