EARLY INTENSIVE REHABILITATION AFTER HIP FRACTURE SURGERY AND ACTIVITIES OF DAILY LIVING IN PATIENTS WITH DEMENTIA

Using a nationwide inpatient database in Japan, this retrospective cohort study examined the effect of early intensive postoperative rehabilitation on activities of daily living (ADL) based on the Barthel Index (BI) after hip fracture surgery in patients with dementia. Patients aged ≥65 years with dementia at admission who underwent hip fracture surgery and received postoperative rehabilitation from 1 April 2014 to 31 March 2016 were included. The average early rehabilitation intensity per day was calculated as the total units of rehabilitation within 7 days after surgery divided by the 7 days and categorized into the following four groups: <1.0 units/day; 1.0–1.9 units/day; 2.0–2.9 units/day; and ≥3.0 units/day. One rehabilitation unit was 20 minutes. A multivariable linear regression analysis was conducted to determine whether early intensive postoperative rehabilitation was associated with better BI at discharge from acute-care hospitals. We identified 42,468 eligible patients (at 1,048 acute-care hospitals). With reference to the least intensive early rehabilitation group, the discharge BI score differences (95% Confidence Intervals [CIs]) were 3.68(3.05–4.30), 6.81(5.87–7.76), and 8.84(7.50–10.17) in the groups with 1.0–1.9, 2.0–2.9, and ≥3.0 unit/day, respectively. These results suggest that early intensive postoperative rehabilitation is associated with a better recovery of ADL in acute care setting among patients with dementia after hip fracture surgery.