Influence of rehabilitation site on hip fracture recovery in community-dwelling subjects at 6-month follow-up

Objective: To evaluate whether postacute rehabilitation after hip fracture influences recovery of prefracture function as detected by the FIM instrument motor scale. Design: Inception cohort. Setting: University-affiliated tertiary care hospital; inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs). Participants: People with acute proximal femur fracture treated between March 1, 2002, and June 30, 2003. Intervention: Post-hip fracture rehabilitation delivered at an IRF or SNF. Main Outcome Measure: FIM motor score estimated prefracture and obtained at 2 weeks and 24 weeks after hospital discharge. Results: Fifty-eight patients were treated at an IRF, whereas 39 were treated at an SNF. Controlling for baseline covariates, a mixed model showed a significant group by time interaction (F-357.1 = 14.27, P <.001). Contrasts indicated that IRF subjects had greater initial improvement. Multiple logistic regression examining factors associated with recovery of FIM motor score to 95% or more of prefracture FIM motor score by 24 weeks found that IRF setting only was associated with recovery of baseline function with odds ratio of 5.44 (95% confidence interval, 2.02-14.65). Conclusions: Even when controlling for important baseline covariates, community-dwelling hip fracture subjects treated in an IRF are more likely to attain 95% or more of prefracture functional status by 24 weeks postdischarge than subjects treated in an SNF.