This study aims to examine the current state of rehabilitation implementation and identify factors influencing sustained rehabilitation in older patients with hip fractures after surgery in Japan, a country facing the challenges of rapid aging.
This retrospective cohort study used databases such as medical and long-term care insurance claims data in Kyoto City, Japan. The participants were patients aged 75 years or older who underwent surgery for hip fractures from April 2013 to October 2018 among the participants in the Medical Care System for the Elderly in the Latter Stage of Life in Kyoto. The primary outcome was the implementation of rehabilitation for six months after hip fracture surgery as a process measure. We used logistic regression analysis to examine factors associated with six-month rehabilitation continuation. This study was conducted by the secondary use of existing anonymized data. Signed informed consent was waived because the researchers received anonymized existing data from Kyoto City.
Of the 8,108 participants, 8,037 (99%) underwent rehabilitation the first month after surgery, but only 1,755 (22%) continued for six months. The following variables were positively associated with continuing rehabilitation for six months: males (adjusted odds ratio: 1.41 [95% confidence interval: 1.23–1.62]), an intermediate frailty risk (1.50 [1.24–1.82]), high frailty risk (2.09 [1.69–2.58]) estimated using the hospital frailty risk scores, and preoperative care dependency levels: support level 1 (1.69 [1.28–2.23]), support level 2 (2.34 [1.88–2.90]), care-need level 1 (2.04 [1.68–2.49]), care-need level 2 (2.42 [2.04–2.89]), care-need level 3 (1.45 [1.19–1.76]), care-need level 4 (1.40 [1.12–1.75]), and care-need level 5 (1.31 [0.93–1.85]). In contrast, dementia negatively affected continuing rehabilitation (0.53 [0.45–0.59]).
Fewer than 30% of older patients continued rehabilitation for six months after surgery. Male sex, higher frailty risk, pre-surgery care dependency, and absence of dementia were identified as factors associated with continuing rehabilitation. Further research is needed to explore unexamined determinants, including ADLs, patient and family perceptions, and regional differences.
Continuing rehabilitation after hip fracture improves physical function and quality of life. Patients with hip fractures may not continue rehabilitation after discharge from acute care hospitals. Establishing a system to promote the continuation of community-based rehabilitation after discharge from hospitals is required.
Post-hospital pathway
Evidence-practice gap
