Does cognitive performance affect physical therapy regimen after hip fracture surgery

Background and aims: To evaluate whether and which clinical factors affect the regimen of physical therapy (PT) treatment in elderly patients after hip fracture (HF). Methods: HF patients consecutively admitted to a rehabilitation unit (from January 2002 to May 2004) without adverse clinical events on admission or during hospital stay were considered (n=80). All patients underwent multidimensional assessment including demographic, clinical, cognitive, affective and functional status. Outcome measure was the number of rehabilitative procedures (NRP), computed as the ratio between sum of rehabilitative procedures and length of hospital stay. Results: Patients received 3.8±1.3 NRP on average, although with large variability. Age and impairment of cognitive and pre-fracture functional status were significantly higher in those receiving fewer NRP. In a multiple regression model, only the Mini Mental State Examination (MMSE) significantly predicted NRP: compared with patients with MMSE ≤17 those with MMSE = 18-23, 24-26 and ≥27 received 0.3 (95% CI - 0.5-1.1, p=0.46), 1.5 (95% CI 0.6-2.4, p=0.001), and 1.6 (95% CI 0.7-2.5, p=0.001) more NRP. Conclusions: Cognitive performance affects NRP in elderly HF patients. Specific rehabilitative approaches, according to baseline cognitive performance, should be considered.