Objective
To examine heterogeneity in 1-year functional recovery following postacute rehabilitation
among older adults with hip fracture.
Methods
Two hundred twenty-five community-dwelling older adults with hip fracture who received
postacute rehabilitation in 5 rehabilitation facilities in Baltimore, Maryland, were
recruited during postacute rehabilitation (baseline) and follow-up at 2, 6, and 12
months following postacute rehabilitation discharge. Functional recovery was measured
by the activities of daily living (ADL) and instrumental activities of daily living
(IADL) scores. A mixed-effect model was used to examine factors associated with postacute
rehabilitation functional recovery; fixed and random effects estimates from the models
were used to demonstrate heterogeneity in functional recovery.
Results
Results indicated that there was an overall trend in both ADL and IADL functional
improvement at 2 months following postacute rehabilitation, with continued improvement
to 6 months, after which functional recovery slowed down and remained constant through
the year. Individuals whose functional recovery did not conform to these patterns
were identified and their functional recovery that deviated substantially from the
group mean was demonstrated.
Conclusions
Functional recovery patterns in elderly hip fracture patients are heterogeneous. To
foster functional independence, health care professionals should consider individual
recovery trajectories using a modeling approach appropriate for longitudinal or repeated
measurement data such as a linear mixed-effects model when designing individualized
rehabilitation and postacute rehabilitation care plans.
Keywords
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Article info
Publication history
Published online: January 18, 2010
Footnotes
This research was funded by the National Institute on Aging, Grant R01 AG15918–02. L.J.B. was supported by funds of the Intramural Research Program of the National Institute on Aging.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
