Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

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• 作者：Amer N. Al-Ani ; MD^a ; ^{amer.al-ani@karolinska.se" class="auth_mail" title="E-mail the corresponding author} ; Lena Flodin ; MD^b ; Anita Sö ; derqvist ; RN ; PhD^c ; Paul Ackermann ; MD ; PhD^e ; Eva Samnegå ; rd ; MD ; PhD^d ; Nils Dalé ; n ; MD ; PhD^d ; Maria Sä ; ä ; f ; MD ; PhD^f ; Tommy Cederholm ; MD ; PhD^g ; Margareta Hedströ ; m ; MD ; PhD^a
• 关键词：Activities of daily living ; Dementia ; Hip fractures ; Rehabilitation ; Walking
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：91
• 期：1
• 页码：51-57
• 全文大小：316 K

文摘

Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.

Objective

To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.

Design

Population-based cohort study.

Setting

A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.

Participants

Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0–2 points] score) in Short Portable Mental Status Questionnaire [0–10 points]) and able to walk before the fracture.

Interventions

Not applicable.

Main Outcome Measure

Walking ability and ADLs index at 4-month and 12-month follow-up.

Results

Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1–7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52–22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44–19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8–3.5; P<.001), while type of surgery was not (P=.376).

Conclusions

Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.