Can hip-fractured elderly patients maintain their rehabilitation achievements after 1 year?

Purpose: The purpose of this study is to characterize hip-fractured patients who maintained or improved their functional ability, 1 year postdischarge from rehabilitation and to identify factors associated with functional achievement maintenance. Methods: A retrospective study performed in a postacute geriatric rehabilitation center. Two hundred thirty-three hip-fractured patients admitted consecutively from January 2006 to September 2007 were enrolled in the study. The patients were evaluated at discharge from rehabilitation and after 1 year, they were classified into two groups: those who maintained or improved their motor Functional Independence Measure (mFIM) scores and those who deteriorated. The differences between the two patient groups relating to functional, clinical, demographic and fracture-related variables were assessed. Results: One year postrehabilitation, 130 (55.8%) patients exhibited a decline in their mFIM score. Patients whose 1-year mFIM score had improved were discharged from rehabilitation with a less favorable mean mFIM score (50.7±18.5 vs. 55.6±15.2; p=0.032), achieved a lower mean mFIM score gain during rehabilitation (12.0±9.7 vs. 14.6±8.1; p=0.03), had a higher education level (p=0.003) and had a lower rate of chronic lung disease (p=0.020) compared with patients whose 1-year mFIM score had deteriorated. After 1 year, only 21 patients (9%) were functionally independent in activities of daily living and only 19 (8.2%) were able to walk unassisted. Only 13 patients (5.6%) perceived that they had regained their former functional level. Conclusions: A substantial decline in functional ability of hip-fractured patients occurred 1 year postdischarge from rehabilitation. Healthcare providers should be aware of the necessity for a long-term postrehabilitation physical training program to prevent functional decline. Further efforts should be invested in motivating their patients to exercise. Implications for Rehabilitation A considerable decline in functional level occurs in elderly following hip fracture after discharge from post-acute rehabilitation program. Functional deterioration is more noticeable among patients who achieved higher functional performance during rehabilitation. To slow down functional decline, providing continuous physical training to hip-fractured elderly patients after discharge from rehabilitation is recommended.