85A PROSPECTIVE STUDY ON FACTORS PREDICTING EARLY FUNCTIONAL OUTCOMES OF HIP FRACTURE REHABILITATION IN A SINGAPORE COMMUNITY HOSPITAL

Abstract

Introduction: Rehabilitation is an integral component of hip fracture management. The majority of the elderly hip fracture population in Singapore undergo rehabilitation in a community hospital. The aim of this study was to determine the factors predicting early functional outcomes post-hip fracture repair, as measured by the Modified Barthel Index (MBI) and De Morton Mobility Index (DEMMI). Method(s): 176 patients >65 years old, admitted consecutively to a community hospital for rehabilitation after surgery for a single fragility hip fracture in 2015, were prospectively recruited as part of an integrated ortho-geriatric hip fracture care pathway from orthopaedic unit to community hospital. Variables including premorbid function, weight bearing status, pain, post-operative medical complications, depression and cognitive status (Mini-Mental State Examination - MMSE) were studied. MBI and DEMMI were measured on admission and following 15 physiotherapy (PT) and 15 occupational therapy (OT) sessions. Result(s): Mean age was 80.6 (SD 7.2), with MBI and DEMMI on admission 43.0 +/- 15.3 and 22.2 +/- 11.4 respectively. Majority had moderate or severe cognitive impairment (MMSE 0-10: 17.1%; MMSE 11-20: 50.6%), 64.3% had 0-1 post-operative medical complications. There was significant improvement in MBI and DEMMI after 15 PT and 15 OT sessions (mean change +13.6 and +14.7; p < 0.001). Performing multivariable linear regression analysis with DEMMI as outcome, the number of post-op medical complications was associated with poor post rehabilitation DEMMI (-1.23 per complication, CI -2.45 to 0.0, p = 0.05) whilst higher premorbid Parker Mobility Index and full weight bearing status were associated with higher DEMMI (+0.93, CI 0.38 to 1.47; +8.31, CI 4.31 to 12.33 p < 0.001). Furthermore, compared with patients with MMSE>20, those with moderate cognitive impairment (MMSE 11-20) and severe cognitive impairment (MMSE 0-10) had lower MBI outcomes (-14.43, CI -20.17 to -8.69 and -33.88, CI -41.32 to -26.44; p < 0.001) and DEMMI outcomes (+8.65, CI -11.99 to -5.31 and -16.51, CI -20.83 to -12.18; p < 0.001). Conclusion(s): These results provide guidance to the interdisciplinary team in prognosticating functional recovery. Presence of medical complications negatively impacts mobility outcomes, reflecting a limiting effect on rehabilitation progress, highlighting a need for quality improvement measures to minimise these complications. Furthermore, cognitive impairment strongly predicted poor mobility and global functional recovery. Future studies need to determine how to best adapt rehabilitation processes to better meet rehabilitation challenges in the cognitively-impaired elderly, hence optimising their outcomes.