Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Am J Phys Med Rehabil. 2010 Jul;89(7):530-40. doi: 10.1097/PHM.0b013e3181e29f54.
To characterize rehabilitation services in two types of postacute facilities in patients who underwent hip replacement following a hip fracture.
Multisite prospective observational cohort from 6 freestanding skilled nursing facilities and 11 inpatient rehabilitation facilities. Patients (n = 218) with hip fracture who had either hemiarthroplasty or total hip arthroplasty followed by rehabilitation at skilled nursing facilities or inpatient rehabilitation facilities were enrolled. Using a point-of-care methodology, we recorded data from actual physical therapy and occupational therapy sessions completed including functional outcomes during the postacute admission.
Onset time from surgical repair to rehabilitation admission was not significantly different between sites. Average skilled nursing facilities length of stay was 24.7 +/- 13.6 days, whereas inpatient rehabilitation facilities was 13.0 +/- 5.7 days (P < 0.01). Total hours of physical therapy and occupational therapy services per patient day were 1.2 in skilled nursing facilities and 2.0 in inpatient rehabilitation facilities. For weekdays only, these data changed to 1.6 in skilled nursing facilities and 2.6 hrs per patient in inpatient rehabilitation facilities (P < 0.01). Patients in inpatient rehabilitation facilities accrued more time for gait training and exercise in physical therapy, which was found to be 48% and 40% greater, respectively, through day 8. In occupational therapy, patients of inpatient rehabilitation facilities had more time allocated to lower body dressing and transfers.
Significant differences in rehabilitation activities were observed, and intensity was notably different within the first 8 therapy days even though baseline demographics and medical complexity were comparable across facility types. Our data suggest that after more complex hip replacement surgery, hip fracture patients can tolerate more intensive therapy earlier within the rehabilitation program.
描述髋部骨折患者接受髋关节置换术后在两种类型的康复机构中接受康复服务的情况。
来自 6 家独立的康复护理机构和 11 家住院康复机构的多站点前瞻性观察队列。招募了在康复护理机构或住院康复机构接受康复治疗的髋部骨折患者（n=218），这些患者接受了半髋关节置换术或全髋关节置换术。使用即时护理方法，我们记录了实际物理治疗和职业治疗完成的疗程中的数据，包括康复住院期间的功能结果。
从手术修复到康复入院的起始时间在各机构之间没有显著差异。康复护理机构的平均住院时间为 24.7+/-13.6 天，而住院康复机构为 13.0+/-5.7 天（P<0.01）。每位患者每天接受的物理治疗和职业治疗服务总时间为康复护理机构 1.2 小时，住院康复机构 2.0 小时。仅在工作日，这些数据分别变为康复护理机构 1.6 小时和住院康复机构 2.6 小时/患者（P<0.01）。住院康复机构的患者在物理治疗中获得了更多的步态训练和运动时间，分别增加了 48%和 40%，直到第 8 天。在职业治疗中，住院康复机构的患者有更多的时间用于下半身穿衣和转移。
尽管基线人口统计学和医疗复杂性在机构类型之间具有可比性，但在康复活动中观察到了显著差异，并且在最初的 8 个治疗日内强度差异明显。我们的数据表明，在接受更复杂的髋关节置换手术后，髋部骨折患者可以在康复计划的早期耐受更密集的治疗。
