Hip fractures: A review of predictors affecting Functional Independence Measure, ambulation and rehabilitation length of stay during inpatient rehabilitation in Singapore General Hospital

Abstract

Introduction: Osteoporotic hip fractures receiving surgery are common and early rehabilitation is needed in the acute hospital setting. In Singapore, many receive rehabilitation after hip surgery in a tertiary hospital, and various clinical variables may be predictors of functional outcomes. Methods: We retrospectively reviewed 68 patients who went through inpatient rehabilitation in Singapore General Hospital. The primary outcomes of this study were to identify predictors which affect Functional Independence Measure (FIM) efficiency and motor FIM gain at discharge. The secondary outcomes include predictors affecting ambulation distance at discharge and rehabilitation length of stay (RLOS). Results: Age, dementia and days from fracture to surgery are important predictors of FIM efficiency; age and FIM efficiency are important predictors of ambulation distance; and type of fracture is an important predictor of RLOS. Patients of age <75 (OR 2.419, p=0.002), absence of dementia (OR 2.570, p=0.045) and those who received surgery <3 days from fracture onset (OR 2.529, p=0.036) achieved greater FIM efficiency. Younger patients of age <75 (OR 23.177, p=0.030) and those with FIM efficiency of more than 7 points per week (OR 38.963, p=0.05) achieved greater ambulation distance at discharge. Type of hip fracture is an important predictor for RLOS, with neck of femur fracture patients having shorter RLOS (OR 7.186, p=0.005). Conclusion: Age, dementia, days from fracture to surgery and type of hip fractures are important predictors of early functional outcomes in inpatient rehabilitation setting.