Mobility assessment of hip fracture patients during a post-acute rehabilitation program

Our aim was to describe improvement in mobility level in hip fracture patients during a post-acute rehabilitation program and examine variables that may impede mobility improvement. A retrospective chart review of 138 patients with a proximal hip fracture, admitted consecutively during 2006 was conducted. Main outcome measurements were: 6-meter-walking-time (6mWT), rate of improvement (RI) in the 6mWT, gait velocity (GV), functional independence measure (FIM), motor FIM (mFIM) and length of stay (LOS). Most patients (118, 85.5%) showed improvement in the 6mWT (mean 16.05 +/- 20.2 s, median 12.08). At discharge, 117 patients (84.7%) achieved GV within household ambulation (< 0.4 m/s). Patients with high initial GV needed shorter rehabilitation time compare to patients with low admission GV (27.5 +/- 12.1 days vs. 31.7 +/- 12.2 days; p = 0.042). The high RI group (>= 1 s/day) achieved significantly higher admission and discharge FIM scores (70.7 +/- 15.9 vs. 64.1 +/- 16.9, p = 0.023; 87.3 +/- 15.8 vs. 79.9 +/- 17.4, p = 0.013, respectively) and higher admission and discharge mFIM scores (45.3 +/- 12.9 vs. 40.8.1 +/- 12.7, p = 0.049; 60.7 +/- 12.4 vs. 56.2 +/- 13.4, p = 0.045, respectively) compared with the low performance group (< 1 s/day). Logistic regression analyzed the variables with significant predictive value for achieving high RI (>= 1 s/day): performance of the 6mWT at FIM >= 4 (OR 1.092; 95% CI, 1.056-1.129) and admission FIM score (OR 1.054; 95% CI, 1.023-1.085). Post-acute hip fracture patients capable of bearing weight on their injured leg, with minimal assistance [manual assistance of <= 25% (FIM >= 4)] may considerably improve their mobility regardless of their disability, cognitive level or neurological history. Most patients achieved GV enabling them to ambulate short distances within the home. (C) 2011 Elsevier Ireland Ltd. All rights reserved.