Rehabilitation in a convalescent rehabilitation ward following an acute ward improves functional recovery and mortality for hip fracture patients: a sequence in a single hospital.
Tomohiro Yoshizawa, Tomofumi Nishino, Hajime Mishima and 2 others
PMID 28626336WHAT IT FOUND
Hip fracture patients who moved to a convalescent rehabilitation ward within the same hospital had higher discharge independence scores and home discharge rates than those discharged directly from the acute ward.
One-year mortality did not differ significantly between the two groups.
Key findings
01Patients in the convalescent rehabilitation ward (CRW) group had significantly higher Functional Independence Measure (FIM) scores at discharge compared to the acute ward group.
02A significantly higher proportion of CRW patients were discharged to home (90.5%) compared to acute ward patients (57.4%).
03There was no significant difference in one-year mortality between the CRW group (2.4%) and the acute ward group (8.3%).
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 was retrospective and non-randomized. Patients were assigned to the CRW or acute ward discharge based on clinician judgment, introducing selection bias. There were significant baseline differences between the groups. The CRW group had more patients living at home prior to injury (93.7% vs. 72.3%) and more patients using a walker prior to injury (28.6% vs. 10.6%), while the acute ward group had more patients in nursing homes and using wheelchairs. The study was conducted in a single hospital in Japan, so the results may not generalize to other healthcare systems or cultural contexts. The CRW group had a much longer hospital stay, which may reflect the nature of the intervention (more time for rehab) rather than just better outcomes per unit of time.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the higher home discharge rate and FIM scores in the CRW group as proof that the ward itself causes better outcomes. The groups were not equivalent at baseline; the CRW group had more patients who lived at home and were more mobile before the fracture, suggesting selection bias favored the CRW group.