Department of Physical Medicine and Rehabilitation, Stony Brook University Medical Center, Stony Brook, NY, USA.
PM R. 2010 Sep;2(9):799-805. doi: 10.1016/j.pmrj.2010.04.019.
To determine the potential predictors of functional outcome after hip fracture rehabilitation in a large acute inpatient rehabilitation facility.
Retrospective chart review study.
Large acute inpatient rehabilitation hospital.
Patients admitted with a primary admitting diagnosis of hip fracture (n = 753). Patients were excluded if their hip fracture was the result of high-velocity trauma and if their stay was shorter than 48 hours (196 patients).
Independent variables included body mass index, gender, ethnicity, smoking history, alcohol consumption, past living situation, past ambulatory status, medical history, prealbumin level, medications that increase the risk of falling, and evidence of prior osteoporosis workup and treatment. These data were entered into a password-encrypted database. Univariate analyses were carried out to evaluate the relationship between independent variables and main outcomes, and multivariate analyses were performed to assess the impact of medical history of diabetes adjusting for other covariates.
Discharge location; length of rehabilitation hospital stay (LOS); Functional Independence Measure (FIM) gain, which is calculated as the FIM(discharge) - FIM(admission); and length of stay efficiency (LOSE), which is calculated as the FIM gain divided by the LOS, and measures the rate of FIM change.
Patients with diabetes had a worse LOSE (P = .0008). Multiple linear regression analysis revealed that patients who have a medical history of diabetes have a 0.33 reduction of LOSE compared with other patients. Predictors of better LOSE included younger age (P < .001), fewer medications that predispose to falls (P < .0001), and independent ambulation before fracture (P = .0003).
We have found several significant patient characteristics that portend a better functional outcome after hip fracture. These include younger age, female gender, absence of diabetes mellitus, independent prefracture ambulation, not living alone before fracture, and being prescribed fewer medications that predispose to falling during rehabilitation. On the contrary, one of our most interesting findings is that patients with diabetes made slower gains, had a longer LOS and were less likely to be discharged directly home from the acute rehabilitation facility. There are numerous factors that may contribute to this, and suggestions are made for future research.
在大型急性住院康复机构中，确定髋部骨折康复后功能结果的潜在预测因素。
回顾性图表审查研究。
大型急性住院康复医院。
患者以髋部骨折的主要入院诊断入院（n=753）。如果他们的髋部骨折是高速创伤的结果，如果他们的住院时间短于 48 小时（196 名患者），则将其排除在外。
独立变量包括体重指数、性别、种族、吸烟史、饮酒史、既往生活状况、既往活动能力、既往病史、前白蛋白水平、增加跌倒风险的药物以及先前骨质疏松症检查和治疗的证据。这些数据被输入到一个密码加密数据库中。进行单变量分析以评估独立变量与主要结局之间的关系，并进行多变量分析以评估在调整其他协变量的情况下糖尿病病史对功能独立性测量（FIM）增益的影响。
出院地点；康复住院时间（LOS）；FIM 增益，计算为 FIM（出院）-FIM（入院）；以及住院时间效率（LOSE），计算为 FIM 增益除以 LOS，用于衡量 FIM 变化率。
患有糖尿病的患者 LOSE 更差（P=.0008）。多元线性回归分析显示，患有糖尿病病史的患者与其他患者相比，LOSE 减少了 0.33。更好的 LOSE 预测因素包括年龄较小（P <.001）、服用易导致跌倒的药物较少（P <.0001）和骨折前独立活动能力（P=.0003）。
我们发现了一些重要的患者特征，这些特征预示着髋部骨折后功能结果更好。这些特征包括年龄较小、女性、无糖尿病、骨折前独立活动能力、骨折前不独居、服用易导致跌倒的药物较少。相反，我们最有趣的发现之一是，糖尿病患者的进展较慢，住院时间较长，从急性康复机构直接出院的可能性较小。有许多因素可能导致这种情况，为未来的研究提出了建议。
