COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION

Radosavljevic, Natasa; Nikolic, Dejan; Lazovic, Milica; Hrkovic, Marija; Ilic-Stojanovic, Olivera

doi:10.1590/1413-785220162404156874

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Acta Ortopédica Brasileira

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Original Article • Acta ortop. bras. 24 (4) • Jul-Aug 2016 • https://doi.org/10.1590/1413-785220162404156874 copy

COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program.

Methods:

This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire.

Results:

There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups.

Conclusion:

Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture. Level of Evidence II, Prognostic Studies .

Keywords:
Hip fracture; Rehabilitation; Elderly; Follow-up studies

Evaluated groups	CIRS-G (degree)	Musculoskeletal impairment	Neurological impairment	Cognitive impairment	p value
Group 1 (MV ± SD)	0	28.07 ± 13.15	28.13 ± 14.66	30.16 ± 14.06	0.474^*
	1	26.13 ± 16.39	27.21 ± 14.81	26.88 ± 14.86	0.952^*
	2	24.93 ± 13.51	20.54 ± 13.52	21.31 ± 11.74	0.417^*
	3	24.91 ± 14.18	20.59 ± 12.45	18.75 ± 10.72	0.249^*
	4	-	13.75 ± 7.56	9.10 ± 12.03	0.267^**
Group 2 (MV ± SD)	0	51.60 ± 13.98	50.29 ± 15.90	53.06 ± 14.33	0.345^*
	1	48.67 ± 18.40	50.00 ± 17.68	48.75 ± 17.40	0.962^*
	2	46.28 ± 14.98	46.43 ± 15.06	43.75 ± 14.68	0.774^*
	3	44.40 ± 14.79	42.29 ± 12.78	37.50 ± 12.86	0.253^*
	4	-	29.69 ± 11.45	30.30 ± 14.59	0.968^**
Group 3 (MV ± SD)	0	64.96 ± 18.16	63.28 ± 20.16	67.34 ± 17.04	0.232^*
	1	58.50 ± 23.63	61.77 ± 21.41	60.31 ± 20.19	0.828
	2	59.60 ± 19.58	51.79 ± 23.44	54.21 ± 22.80	0.422^*
	3	56.71 ± 21.56	52.21 ± 20.84	45.83 ± 18.69	0.221^*
	4	-	37.50 ± 16.37	27.80 ± 19.35	0.230^**
Group 4 (MV ± SD)	0	75.11 ± 21.95	72.80 ± 23.96	77.47 ± 19.86	0.252^*
	1	64.63 ± 27.71	63.24 ± 27.41	69.06 ± 22.64	0.630^*
	2	69.79 ± 25.13	56.21 ± 28.02	57.69 ± 31.04	0.143^*
	3	59.57 ± 26.96	57.35 ± 25.79	45.14 ± 21.07	0.153^*
	4	-	34.38 ± 17.36	29.45 ± 22.07	0.478^**

Evaluated groups	CIRS-G (degree)	Musculoskeletal impairment		Neurological impairment		Cognitive impairment
Evaluated groups	CIRS-G (degree)	N	(F value) ^†	N	(F value) ^†	N	(F value) ^†
Groups 1-4	0	62	87.168**	147	151.851**	109	168.584**
	1	75	44.313**	17	10.828**	40	36.919**
	2	37	39.071**	14	8.196**	26	15.219**
	3	29	17.889**	17	12.685**	18	10.672**
4	0	-	8	4.704**	10	3.344*

CIRS-G (degree)	Evaluated groups	Musculoskeletal impairment^†	Neurological impairment^†	Cognitive impairment^†
0	Groups 1/2	0.783	0.820	0.794
	Groups 1/3	0.622	0.742	0.696
	Groups 1/4	0.581	0.696	0.633
	Groups 2/3	0.765	0.895	0.862
	Groups 2/4	0.765	0.843	0.789
1	Groups 1/2	0.867	0.858	0.846
	Groups 1/3	0.837	0.837	0.735
	Groups 1/4	0.789	0.765	0.653
	Groups 2/3	0.919	0.903	0.904
	Groups 2/4	0.877	0.766	0.814
2	Groups 1/2	0.796	0.919	0.786
	Groups 1/3	0.740	0.785	0.801
	Groups 1/4	0.655	0.683	0.791
	Groups 2/3	0.903	0.905	0.936
	Groups 2/4	0.828	0.826	0.864
3	Groups 1/2	0.876	0.816	0.800
	Groups 1/3	0.849	0.792	0.826
	Groups 1/4	0.849	0.715	0.712
	Groups 2/3	0.892	0.820	0.765
	Groups 2/4	0.825	0.776	0.746
4	Groups 1/2	-	0.851	0.912
	Groups 1/3	-	0.830	0.946
	Groups 1/4	-	0.646	0.924
	Groups 2/3	-	0.715	0.868
	Groups 2/4	-	0.646	0.843

SF-36 SFC	Musculoskeletal impairment			Neurological impairment		Cognitive impairment
SF-36 SFC	F value ^†	η² (%)	F value ^†	η² (%)	F value ^†	η² (%)
Group 1	0.498	0.75	3.434*	6.49	8.465**	14.60
Group 2	1.642	2.42	4.150**	7.74	9.374**	15.92
Group 3	1.487	2.19	4.568**	8.45	14.718**	22.92
Group 4	3.165*	4.55	6.956**	12.32	18.498**	27.20

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[1] Correspondence: Dejan Nikolic. Institute for Rehabilitation, Street: Sokobanjska 17, 11000 Belgrade, Serbia. denikol27@gmail.com