REHABILITATION AND FUNCTION RECOVERY AFTER HIP FRACTURE

描述：（改编自研究者摘要）本研究的长远目标是了解老年髋部骨折患者急性期后康复的效果，并改善其功能独立性。具体目的是：(1)对急性后康复设施的使用模式和患者选择康复地点的相关因素进行流行病学研究；(2)探讨急性后康复对功能恢复的短期和长期影响的相关因素。急性后康复量对功能评分的剂量效应将在调整患者特征和其他可能的共同因素后进行测试；(3)探讨髋部骨折患者在急性期和急性期后的医疗保险支付相关因素，并计算成本-效果比。髋部骨折是65岁及以上老年人的一个主要问题，它会导致严重的死亡率、发病率和功能损害。功能独立性的丧失给个人和护理人员带来了沉重的负担，并需要昂贵的长期护理。康复作为一种三级预防，旨在恢复骨折前的自主性和功能独立性。以前的研究已经检查了老年髋部骨折患者的功能恢复，这些患者大多在住院康复环境中接受干预。很少有研究考察急性后康复对多种环境（住院、门诊或亚急性康复环境）功能结果的有效性，并考虑到所接受的康复服务的强度和数量。该研究将采用纵向队列设计，前瞻性地收集和分析急性康复后对功能结局和成本的人口统计学、医学和社会心理影响。受试者将是300名社区居住的单侧髋部骨折的老年人，他们接受了手术修复（内固定、半关节置换术或全髋关节置换术），并在预定的住院、门诊或亚急性康复机构中接受了规定的急性后康复。将通过反复访谈调查和医疗保险索赔数据收集人口统计、医学、心理社会特征和功能状态的纵向数据。目的是本研究的结果将提供选择和使用急性后康复设置的流行病学数据，以及急性后康复对功能恢复和费用的有效性的信息。研究结果将有助于制定干预方案，以改善老年髋部骨折患者的功能独立性。

DESCRIPTION: (adapted from Investigator's abstract) The broad, long-term objectives of this proposal are to understand the effects of post-acute rehabilitation and to improve functional independence among older hip fracture patients. The specific aims are: (1) To conduct an epidemiologic study of the pattern of use of post-acute rehabilitation facilities and the factors associated with choice of rehabilitation locations where patients receive their prescribed post-acute rehabilitation; (2) To examine the factors associated with the short-term and long-term effect of post-acute rehabilitation on functional recovery. The dose response effect of the amount of post acute rehabilitation on functional score will be tested adjusting for patient characteristics and other potential cofounders; (3) To examine the factors associated with Medicare payment incurred due to hip fracture in both the acute and post- acute care setting and to calculate the cost-effectiveness ratio. Hip fracture, a major problem of persons ages 65 and over, causes significant mortality, morbidity, and functional impairment. The loss of functional independence imposes a heavy burden on individuals, caregivers, and requires costly long-term care. Rehabilitation, as a tertiary prevention, is intended to restore prefracture autonomy and functional independence. Previous studies have examined functional recovery among elderly hip fracture patients' who received interventions mostly in inpatient rehabilitation settings. Few studies have examined the effectiveness of post acute rehabilitation on functional outcome in multiple settings (inpatient, outpatient or subacute rehabilitation settings) and take into account the intensity and quantity of rehabilitation services received. The proposed study will use a longitudinal cohort design prospectively to collect and analyze demographic, medical, and psychosocial impacts of post acute rehabilitation on functional outcome and cost. Subjects will be a sample of 300 community- dwelling elders with unilateral hip fracture, who have had a surgical repair (internal fixation, hemiarthroplasty, or total hip replacement), and received prescribed post acute rehabilitations in any one of the predetermined inpatient, outpatient, or subacute rehabilitation facilities. The longitudinal data on demographic, medical, psychosocial characteristics and functional status will be collected through repeated interview surveys and Medicare claims data. The intent is that the results of this study will provide epidemiologic data on choice and utilization of post acute rehabilitation settings, and information on the effectiveness of post acute rehabilitation on functional recovery and cost incurred. Findings will be useful for developing intervention programs to improve functional independence among elderly hip fracture patients.