Functional gain of hip fracture patients in different cognitive and functional groups

Objective: To follow up six months post hip fracture and to compare functional gain of patients in different cognitive and functional groups. Design: Prospective longitudinal study of hip fracture patients with functional evaluation pre-fracture, prior to discharge from orthopaedic department and one, three and six months post fracture. Setting: Department of Orthopaedics, Rabin Medical Center, Golda Campus with follow-up at Beit-Rivka Geriatric Rehabilitation Hospital, both in Petach Tikvah, Israel, with a minority of patients followed at home or nursing home. Measurement: Cognition evaluated by Mini-Mental State Examination, pre-fracture functioning by Functional Independence Measure and Katz Index of ADL. Functional outcome assessed by Functional Independence Measure gain defined as the difference between Functional Independence Measure scores at six months and just prior to discharge from the Department of Orthopaedics. Results: Moderately cognitively impaired and normal patients had the same Functional Independence Measure -A (self-care) and Functional Independence Measure -B (motor) gains. Pre-fracture independent patients had significantly higher Functional Independence Measure -A and Functional Independence Measure -B gains. A multiple regression analysis examining age, sex, Mini-Mental State Examination score, Katz score, type of fracture, surgery versus conservative treatment and the pre-fracture Functional Independence Measure score showed that only the pre-fracture Functional Independence Measure B scores and Katz scores are the independent variables for motor and self-care gains, respectively. Conclusions: Pre-fracture motor and not cognitive level has been the most important predictive factor for motor gain after hip fracture. Cognitively impaired hip fracture patients can achieve and maintain the same motor functional gain as normal patients, if they were mobile pre-fracture.