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Determinants of functional outcome in hip fracture: the role of comorbidity

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Abstract

Background and aims

Executed studies did not clearly identify which index of comorbidity was an independent outcome determinant. The aim of this prospective observational cohort study was to address this issue.

Methods

We analyzed 200 consecutive patients with hip fracture. All patients underwent rehabilitation. At admission comorbidity was assessed through the cumulative severity, severity index, and comorbidity index of the Cumulative Illness Rating Scale. Discharge scores and effectiveness in the Functional Independence Measure motor subscale, and discharge destination were the outcome measures. Multivariate regression analyses were performed to identify determinants of outcome.

Results

Mini Mental State Examination and comorbidity index of the Cumulative Illness Rating Scale were important independent determinants of final (respectively, β = 0.46 and −0.25) and effectiveness (respectively, β = 0.47 and −0.25) in motor Functional Independence Measure scores, while hip strength and Rankin score were determinants of final motor Functional Independence Measure score (respectively, β = 0.21 and −0.20). Comorbidity index of the Cumulative Illness Rating Scale (odds ratio 8.18 for ≥3 versus < 3 comorbidity score; 95% confidence interval, 1.03–64.7) and Geriatric Depression Scale (odds ratio 4.02 for ≥6 versus ≤5 depression scale score; 95% confidence interval, 1.52–10.63) were risk indicators for nursing home.

Conclusions

Among the indices of the Cumulative Illness Rating Scale, comorbidity index is the sole independent determinant of both motor Functional Independence Measure scores and discharge destination in hip fracture patients. This suggests to specifically evaluate this index to identify the patients who may be admitted to a rehabilitation program.

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Acknowledgements

The authors thank Rosemary Allpress for English revision of the manuscript.

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Authors and Affiliations

  1. Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Lumezzane, Via G Mazzini, 129, 25065, Lumezzane (Brescia), Italy

    Bernardo Gialanella, Cristina Ferlucci & Laura Comini

  2. Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Castelgoffredo, Mantova, Italy

    Paola Prometti

  3. Istituti Clinici Scientifici Maugeri, Institute of Lissone, Lissone (Milano), Italy

    Vittoria Monguzzi

  4. Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Pavia, Pavia, Italy

    Paola Baiardi

Authors
  1. Bernardo Gialanella
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  2. Paola Prometti
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  3. Vittoria Monguzzi
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  4. Cristina Ferlucci
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  5. Paola Baiardi
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  6. Laura Comini
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Corresponding author

Correspondence to Bernardo Gialanella.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The research was not supported by Pharmaceutical Companies, but by institutional funding.

Ethical approval

The Technical Scientific Committee of our Institute approved the study protocol. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent

All patients gave their written informed consent to participate.

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Gialanella, B., Prometti, P., Monguzzi, V. et al. Determinants of functional outcome in hip fracture: the role of comorbidity. Aging Clin Exp Res 30, 643–650 (2018). https://doi.org/10.1007/s40520-017-0812-x

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  • DOI: https://doi.org/10.1007/s40520-017-0812-x

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