Cognitive assessment to optimize prediction of functional outcome in subacute hip fracture: a short-term prospective study.
Marco DI Monaco, Maria Sgarbanti, Silvia Trombetta and 7 others
PMID 38483331WHAT IT FOUND
In hip fracture patients who passed a basic cognitive screen, a more detailed MoCA test predicted discharge independence.
Patients with a seven-point lower MoCA score had about half the odds of reaching a successful rehabilitation outcome. Adding other cognitive tests did not improve this prediction.
Key findings
01The Montreal Cognitive Assessment (MoCA) score was the only cognitive test that significantly predicted both the final functional score and successful rehabilitation after adjusting for age, prior function, fracture type, vitamin D, and neurologic disease.
02For every seven-point difference in MoCA score, the odds of achieving a successful rehabilitation outcome (Barthel Index ≥85) changed by a factor of nearly two in the full group, and more than two in the subgroup with no or one error on the initial screen.
03The initial screening test (SPMSQ) missed patients whose cognition would predict poor outcomes, and adding the Frontal Assessment Battery or Rey Auditory Verbal Learning Test did not improve prediction over MoCA alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study excluded patients with overt cognitive impairment (more than four errors on the SPMSQ), so the findings do not apply to patients with moderate to severe dementia. The results are from a single rehabilitation ward in Italy, which may limit how well they apply to other healthcare systems or patient populations. The study only looked at short-term outcomes at discharge; it did not track how patients were doing months later. Several factors known to affect recovery, such as depression, fear of falling, and social support, were not measured or adjusted for in the analysis. The definition of 'successful rehabilitation' (Barthel Index ≥85) was chosen by the researchers and is not a universally agreed-upon threshold.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that a patient who passes a basic cognitive screen like the SPMSQ has no cognitive barriers to rehabilitation. The study shows that the SPMSQ missed patients whose MoCA scores predicted poor functional outcomes. A normal screen does not mean the patient will regain independence.