Article

OBJECTIVE: To examine the association of weight-bearing status with
patient-related variables and outcomes of inpatient rehabilitation after hip
arthroplasty for acute hip fracture. DESIGN: A multi-site prospective
observational cohort study. SETTING: Eighteen skilled nursing and inpatient
rehabilitation facilities. SUBJECTS: Patients with hip fractures (N = 224)
treated with hip arthroplasty and admitted to either skilled nursing or inpatient
rehabilitation facilities; a subset (N = 84) with telephone follow-up outcomes 8
months after rehabilitation discharge. METHODS: Measurements included demographic
variables, medical severity using the Comprehensive Severity Index, and
functional levels using the Functional Independence Measure. MAIN OUTCOMES
MEASUREMENT: Cognitive, motor, and total Functional Independence Measure scores
at rehabilitation discharge and at 8-month follow-up; living location at
discharge and follow-up. RESULTS: Patients on average (standard deviation) were
76.8 +/- 11.4 years old, mainly women (78%), and mainly white (87%). In
unadjusted analysis, weight bearing as tolerated (WBAT) was associated with less
osteoarthritis (P = .025) and lower admission medical severity (ACSI) (P = .014).
One participating facility had a significant preponderance of restricted
weight-bearing cases. WBAT had no bivariate association with cognitive or motor
function at discharge. Therapists cited restricted weight bearing as a barrier to
therapy in 11% of cases. In logistic regressions, lower medical admission
severity, older age, and one specified site significantly predicted WBAT (c
statistic = 0.714). Significant predictors for home discharge included lower
maximum severity (P < .001), younger age (P < .001), higher cognition (P = .037),
and WBAT (P = .051) (c statistic = 0.863). CONCLUSIONS: WBAT is associated with a
greater likelihood of home discharge and had similar functional outcomes compared
with restricted weight bearing. These findings add support for allowing WBAT
after arthroplasty for hip fracture.
CI - Copyright (c) 2012 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS