Article

The aim of this study was to assess the relationship between
self-reported disease burden (stroke, congestive heart failure, diabetes, chronic
obstructive pulmonary disease, arthritis, or cancer) and functional improvement
during and after inpatient rehabilitation among older adults with hip fractures.
DESIGN: This is a longitudinal study examining 238 community-dwelling adults 65
yrs or older with unilateral hip fractures who underwent surgical repair and
inpatient rehabilitation and were followed for 1 yr after discharge from the
inpatient rehabilitation facility. The Functional Independence Measure (FIM)
instrument was the outcome variable, collected at inpatient rehabilitation
facility admission and discharge and at 2, 6, and 12 mos after discharge from the
inpatient rehabilitation facility.
A mixed-effect model was applied to quantify
FIM functional improvement patterns between groups with and without selected
preexisting chronic conditions while adjusting for potential confounders.
RESULTS: Maximum functional improvement occurred during rehabilitation and the
first 6 mos after rehabilitation for all six chronic conditions under study. In
regard to the effect of disease on selected FIM outcomes, compared with patients
without the selected preexisting chronic conditions, those who have had a stroke
had significantly worse self care (beta = -0.33; P = 0.02), transfer (beta =
-0.36; P = 0.03), and locomotion (beta = -0.84; P = 0.0005) ratings, whereas the
patients with congestive heart failure had significantly worse transfer (beta =
-0.59; P = 0.001) and locomotion (beta = -0.71; P = 0.01) ratings. Significant
interactions in stroke with time were seen in self-care (beta = -0. 03; P =
0.04), suggesting that those who have had a stroke before hip fracture had poorer
functional improvement over time than those who did not have the conditions. The
patients with congestive heart failure demonstrated a faster rate of recovery
over time in locomotion than those without (beta = 0.06; P = 0.03). CONCLUSIONS:
Intervention strategies should monitor the first 6 mos after discharge from
inpatient rehabilitation, during which the maximum level of functional
improvement is expected. However, the individuals who have had a stroke had poor
functional improvement at 1 yr (adjusted mean FIM score, 5.74) than those who
have not had a stroke (adjusted mean FIM score, 6.56). The patients who have had
a stroke required human supervision at 12 mos after rehabilitation. Therefore,
long-term care needs should be monitored in the discharge plan.

Langue : ANGLAIS