Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients

Abstract

Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.

Objective: To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.

Design: Population-based cohort study.

Setting: A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.

Participants: Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture.

Interventions: Not applicable.

Main outcome measure: Walking ability and ADLs index at 4-month and 12-month follow-up.

Results: Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44-19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8-3.5; P<.001), while type of surgery was not (P=.376).

Conclusions: Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.