Open Access Highly Accessed Research article

Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment

Katherine S McGilton12*, Aileen M Davis3, Gary Naglie4, Nizar Mahomed3, John Flannery5, Susan Jaglal16, Cheryl Cott16 and Steven Stewart7

Author Affiliations

1 Department of Research, Toronto Rehabilitation Institute, E.W. Bickle Centre for Complex Continuing Care, 130 Dunn Avenue, Toronto, ON M6K 2R7, Canada

2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T1P8, Canada

3 Division of Health Care and Outcomes Research, Toronto Western Research Institute, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada

4 Department of Medicine, Baycrest Geriatric Health Care Centre, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada

5 MSK Rehabilitation Program, Toronto Rehabilitation Institute, University Centre, 550 University Ave, Toronto, ON M5G 2A2, Canada

6 Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada

7 School of Kinesiology and Health Studies, Queen’s University, 28 Division St., Kingston, ON K7L 7N9, Canada

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BMC Geriatrics 2013, 13:136  doi:10.1186/1471-2318-13-136

Published: 13 December 2013

Abstract

Background

The purpose of this study was to evaluate outcomes for older persons post-hip fracture repair, including those with cognitive impairment (CI), following implementation of a novel model of care – the Patient-Centered Rehabilitation Model including persons with CI (PCRM-CI). The PCRM-CI is an interdisciplinary rehabilitation program that incorporates education for healthcare professionals (HCPs), including nurses, which is focused on geriatric care including management of dementia and delirium, support for HCPs from an Advanced Practice Nurse, and family support and education. Primary outcome measures were mobility gain from admission to discharge and whether or not patients returned home post-discharge.

Methods

The PCRM-CI intervention was evaluated using a quasi-experimental design, following implementation in two community hospital inpatient rehabilitation units. One hundred forty-nine patients aged 65 and older participated as patients in the usual care (76) or PCRM-CI intervention (73) groups. Patient mobility was assessed at admission and discharge by the Functional Independence Measure Motor Subscale (FIMM); the difference in mobility scores was defined as mobility gain. Patient discharge location was also captured to determine whether or not patients returned home from inpatient rehabilitation.

Results

No difference in mobility gain was found between the usual care and PCRM-CI groups as measured by the FIMM. Patients in the intervention group were more likely to return home post-discharge than those in the usual care group (p = 0.02).

Conclusions

Results of the PCRM-CI evaluation suggest that older adults with CI can successfully be rehabilitated post-hip fracture repair using this novel, interdisciplinary rehabilitation program.

Trial registration

This trial has been registered with the US National Institutes of Health (ID: NCT01566136)

Keywords:
Person-centered care; Cognitive impairment; Rehabilitation; Healthcare restructuring; Hip fracture