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. 2023 Dec;59(6):743-753.
doi: 10.23736/S1973-9087.23.07900-5. Epub 2023 Sep 26.

Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study

Intonia H Chow  1   2 , Tiev Miller  2   3   4 , Marco Y Pang  5
Affiliations

Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study

Intonia H Chow et al. Eur J Phys Rehabil Med. 2023 Dec.

Abstract

Background: Femoral fractures require protracted hospitalization and often preclude return to pre-fracture levels of mobility, function and prior residential status following hospital discharge. Early prediction of rehabilitation and discharge potential in patients with femoral fracture would optimize discharge planning.

Aim: To identify predictive factors of discharge destination during the early phase of femoral fracture rehabilitation.

Design: Prospective cohort design.

Setting: Acute and postoperative rehabilitation hospital settings.

Population: Data from 109 participants (65 women [59.6%]) admitted for unilateral femoral fracture were included.

Methods: Sociodemographic information, hip pain severity during gait (Numeric Pain Rating Scale), mobility (Elderly Mobility Scale), activities of daily living (Modified Barthel Index), cognition (Mini-Mental State Examination [MMSE]), exercise self-efficacy (Self-Efficacy for Exercise Scale), amount of physiotherapy received, and caregiver availability were assessed pre- and/or postoperatively. Discharge destination was assessed via telephone interviews 6 weeks after discharge from acute care. Receiver operating characteristic curves were used to determine optimal cut-off scores for all outcomes based on discharge destination. Outcomes demonstrating a significant area under the curve were entered as dichotomous independent variables (i.e., above or below ROC-derived cut-off values) in subsequent logistic regression analyses to determine predictors of discharge destination.

Results: SEE Score ≥53 (odds ratio [OR]=5.975, 95% confidence interval [CI]=1.674-21.333, P=0.006), female sex (OR=3.421, 95% CI=1.187-9.861, P=0.023), ≥8 physiotherapy sessions (OR=4.633, 95% CI=1.559-13.771, P=0.006), MMSE Score ≥17 (OR=3.374, 95% CI=1.047-10.873, P=0.042), and caregiver availability (OR=3.766, 95% CI=1.133-12.520, P=0.030) were identified as significant predictors of home discharge.

Conclusions: Exercise self-efficacy, female sex, more physiotherapy rehabilitation training, better pre-operative cognitive function, and caregiver availability emerged as important predictors of home discharge following femoral fracture.

Clinical rehabilitation impact: These findings are highly translational and may be useful for informing clinical guidelines and policy decisions regarding rehabilitation potential and discharge pathway selection during early hospitalization following femoral fracture surgery.

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Conflict of interest statement

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—Flowchart of participant recruitment, screening, enrolment & clinical treatment pathway.
See this image and copyright information in PMC

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