Pauta del cambio funcional durante la rehabilitación de pacientes con fractura d

Nancy K. Latham PhD, PTa, , , Diane U. Jette DSc, PTb, Reg L. Warren PhDc and Christopher Wirtalla BAc

aHealth and Disability Research Institute, Boston University, Boston, MA bPhysical Therapy, Simmons College, Boston, MA cSeniorMetrix Inc, Nashville, TN

Abstract

Latham NK, Jette DU, Warren RL, Wirtalla C. Pattern of functional change during rehabilitation of patients with hip fracture.

Objective To examine the rate of functional change in 2 domains, activities of daily living (ADLs) and mobility, over 2 time periods during hip fracture rehabilitation.

Design Retrospective analysis of data contained in an administrative dataset.

Setting Seventy skilled nursing facilities (SNFs).

Participants People (N=351) receiving rehabilitation in SNFs from March 1998 to February 2003 after hip fractures.

Interventions Not applicable.

Main Outcome Measure Rate of change in scores in the ADL and mobility domains of the FIM instrument during 2 time intervals of rehabilitation.

Results The rate of functional change across 2 time intervals was constant for mobility (mean change in FIM points per day, .46 vs .49), but declined in the second time period for ADLs (mean change in FIM points per day, .55 vs .41). Executive function, length of stay (LOS), and medical complexity were related to rate of change in mobility, and baseline ADLs, executive function, living setting, and LOS were related to rate of change in ADLs. There was an interaction between rehabilitation phase and baseline mobility. People with lower baseline mobility had an increased rate of change during the second interval (mean change in FIM points per day, .41 vs .55), whereas those with higher baseline mobility had a decreased rate of change (mean change in FIM points per day, .50 vs .43).

Conclusions The pattern of functional change over time differed for ADL and mobility domains, and for specific groups of patients. The results have implications for goal setting and discharge planning.