Article

OBJECTIVE: To assess whether clusters of patients with hip fracture and with
distinct initial recovery trajectories (IRT) could be identified by using
practice-based evidence data and to examine the validity of these data. DESIGN:
Analysis of multisite prospective observational cohort study database. SETTING:
Eighteen skilled nursing and inpatient rehabilitation facilities. PATIENTS:
Patients with hip fractures
(N = 226) treated with joint replacement and admitted
to skilled nursing or inpatient rehabilitation facilities, subset
(n = 85), with
telephone follow-up results approximately 8 months after rehabilitation
discharge. Patients' ages were 76.8 +/- 11.4 years; the majority were women (78%)
and white (87%). METHODS: Measurements included medical severity by using the
Comprehensive Severity Index and functional levels by using Functional
Independence Measure (FIM). The IRT was calculated for each patient as the rate
of change in function from the time of surgery to rehabilitation admission. We
used cluster analysis to partition patients into subsets that shared common IRT
scores. Validity was explored by comparing subgroups across patient
characteristics and treatment patterns. Significance was defined as P </= .05.
MAIN OUTCOMES MEASUREMENTS: IRT grouping, Comprehensive Severity Index, FIM,
discharge location, living location at follow-up. RESULTS: We identified 3
patient clusters with differentiated IRT scores: group 1: 4.96 +/- 2.45 (range,
0.4-8.6) FIM point change per day; group 2: 12.42 +/- 2.51 (range, 8.9-17.0);
group 3: 26.80 +/- 13.78 (range, 17.5-70.0). Clinical group validation was
established from statistically different Comprehensive Severity Index scores on
admission; FIM scores at admission, discharge, and follow-up; and discharge and
8-month living settings. Calculation of IRT recovery curves by using FIM scores
and associated time in days through logarithmic regression curves confirmed each
group's IRT remained distinct through rehabilitation and follow-up. CONCLUSIONS:
The IRT concept appears to be valid in patients with hip fracture who were
treated with hip arthroplasty, and may assist in evaluating and comparing the
effectiveness of postacute rehabilitation services.
CI - Copyright (c) 2012 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS