Post-hip fracture rehabilitation outcomes of diabetic and non-diabetic elderly patients

Figures & data

Table 1. Baseline characteristics of elderly patients with or without diabetes admitted to rehabilitation after hip fracture.

Variable	DM	Non-DM	p Value
N (%)	193 (30.6)	437 (69.4)
Age, years	81.4 ± 7.6	84.3 ± 7.1	< .01
Sex			.85
Female, n (%)	135 (69.9)	309 (70.7)
Male, n (%)	58 (30.1)	128 (29.3)
Rehabilitation duration, days	29.2 ± 9.9	28.6 ± 9.4	.46
Clinical data at admission for rehabilitation
BMI, kg/m^2	26.33 ± 4.81	24.69 ± 4.34	< .01
Smoking, n (%)	28 (14.5)	48 (11.0)	.21
Hypertension, n (%)	161 (83.4)	313 (71.6)	< .01
Ischaemic heart disease, n (%)	54 (28.0)	78 (17.8)	< .01
Cerebrovascular disease, n (%)	63 (32.6)	98 (22.4)	< .01
Chronic kidney disease, n (%)	70 (36.3)	108 (24.7)	< .01
Obesity, n (%)	36 (18.7)	49 (11.2)	.01
Dyslipidaemia, n (%)	126 (65.3)	200 (45.8)	< .01
Use of lipid-lowering medications, n (%)	94 (48.7)	148 (33.9)	<.01
Pressure sores, n (%)	28 (14.5)	40 (9.2)	.046
Laboratory data on admission for rehabilitation
Creatinine, mg/dl	1.06 ± 0.48	0.99 ± 0.47	.01
Total cholesterol, mg/dl	159.98 ± 38.55	168.40 ± 35.19	< .01
Cognitive and functional status on admission for rehabilitation
Mini-mental status exam	21.0 ± 6.61	21.29 ± 6.91	.47
Cognitive FIM	23.72 ± 6.04	23.67 ± 6.08	.97
Motor FIM	39.22 ± 11.24	40.27 ± 11.50	.29

Statistically significant p values are in bold.

Table 2. Rehabilitation outcomes of elderly patients with or without diabetes after hip fracture.

Variable	DM	Non-DM	p Value
N (%)	193 (30.6)	437 (69.4)
Discharge destination			.32
Home, n (%)	178 (92.2)	392 (89.7)	–
Nursing care, n (%)	15 (7.8)	45 (10.3)	–
Delta motor FIM	15.6 ± 8.9	14.8 ± 8.8	.35
Recurrent fracture, n (%)^a	13 (6.7)	25 (5.7)	.62
Recurrent hospitalization, n (%)^a	70 (36.3)	142 (32.5)	.35
Mortality, n (%)^a	21 (10.9)	29 (6.6)	.07

^aWithin 1 year of discharge from rehabilitation.

Table 3. Regression analyses of multivariate models predicting rehabilitation outcomes of elderly patients after hip fracture.

Variable	Delta motor FIM^α	Discharge destination^β	Recurrent fractures^β	Recurrent hospitalization^β	Mortality^β
Age	−0.18**	1.04	0.93**	1.01	1.11**
Sex (male)	0.10*	1.26	0.82	0.95	0.94
BMI	0.10*	0.93	0.97	1.01	0.87**
Ischaemic heart disease	0.00	0.54	1.72	1.31	0.55
Cerebrovascular disease	−0.05	1.43	1.51	1.21	1.30
Chronic kidney disease	−0.04	0.59	0.52	1.09	0.27*
Creatinine	0.03	0.83	1.42	1.18	1.93
Cholesterol	−0.04	0.99	0.99	0.99	0.99
Diabetes mellitus	0.01	0.95	1.04	1.13	2.78*
R^2 (%)	8.5	5.4	6.7	1.8	14.1

^αStandardized coefficients of regression predicting delta motor FIM.

^βOdds ratio of logistic regressions predicting discharge to a nursing care facility at the end of rehabilitation and recurrent fracture, recurrent hospitalization and mortality within 1 year of discharge from rehabilitation.

Statistically significant p values were bolded. *p < .05 and **p < .01.

Table 4. Logistic regressions of multivariate models predicting rehabilitation outcomes of elderly patients with diabetes mellitus after hip fracture.

Variable	Delta motor FIM^α	Discharge destination^β	Recurrent fractures^β	Recurrent hospitalization^β	Mortality^β
Age	−0.26**	1.02	0.89*	1.01	1.01
Sex (male)	0.08	5.25	0.41	1.01	0.74
BMI	0.03	0.76*	0.99	1.02	0.91
Ischaemic heart disease	−0.04	0.33	3.21	1.22	1.03
Cerebrovascular disease	−0.04	2.15	1.10	1.34	1.03
Chronic kidney disease	−0.01	2.77	0.14	0.53	0.37
Creatinine	−0.06	0.07	3.18*	3.68*	2.64
Cholesterol	−0.03	1.03**	0.99	0.99	1.00
R^2 (%)	4.0	34.5	21.8	5.7	10.9

^αStandardized coefficients of regression predicting delta motor FIM.

^βOdds ratio of logistic regressions predicting discharge to a nursing care facility at the end of rehabilitation and recurrent fracture, recurrent hospitalization, and mortality within 1 year of discharge from rehabilitation.

Statistically significant p values were bolded. *p < .05 and **p < .01.

Table

Discipline	Intervention	Availability
Medical care^a	Assess and treat health conditions Periodic geriatric assessment	24 h/d, 7 d/weeks
Nursing	Assess physical condition Wound care and manage medications Evaluate self-care skills Evaluate family and home care factors Self-care training Patient and family education	24 h/d, 7 d/weeks
Physical therapy	Assess range of motion and strength Assess gait and mobility Exercise training	5 h/d, 5 d/weeks
Occupational therapy	Evaluate activities of daily living Evaluate cognition and mood Self-care skills training Fabricate splints Treat upper extremity deficits	5 h/d, 5 d/weeks
Speech therapy	Assess and treat speech impairments Assess and treat swallowing impairments	As needed
Nutrition	Assess nutritional status Revise diet to maximize nutrition	5 h/d, 5 d/weeks
Social work	Evaluate family and home care factors Assess psychosocial factors Counselling Liaison with the community	8 h/d, 5 d/weeks

^aThe physician staff includes geriatric specialists available 8 h a day, 5 d a week and general practitioners who attend to urgent medical conditions on evenings and weekends.

Table

Motor subscale	Cognition subscale
Eating	Comprehension
Grooming	Expression
Bathing	Social interaction
Dressing, upper body	Problem solving
Dressing, lower body	Memory
Toileting	–
Bladder management	–
Bowel management	–
Transfers – bed/chair/wheelchair	–
Transfers – toilet	–
Transfers – bath/shower	–
Walk/wheelchair	–
Stairs	–

Each item is scored on a 7-point ordinal scale, ranging from 1 to 7. The higher the score, the more independent the patient is in performing the task associated with that item. 1 – Total assistance with helper, 2 – Maximal assistance with helper, 3 – Moderate assistance with helper, 4 – Minimal assistance with helper, 5 – Supervision or setup with helper, 6 – Modified independence with no helper, and 7 – Complete independence with no helper.

The total score for the FIM motor subscale (the sum of the individual motor subscale items) is a value between 13 and 91. The total score for the FIM cognition subscale (the sum of the individual cognition subscale items) is a value between 5 and 35. The total score for the FIM instrument (the sum of the motor and cognition subscale scores) will be between 18 and 126.

Data availability statement

Data are available upon reasonable request from the corresponding author.