2021 Volume 23 Issue 1 Pages 3-9
Purpose: Recovery of ADLs in postoperative rehabilitation is known to be associated with such factors as pre-fracture condition and the complications of dementia. We previously reported the usefulness of classifying fracture patients into six groups using a combination of the Barthel Index (BI) and “independent ADL assessment criteria for elderly people with dementia” (independent dementia criteria) to predict their prognoses. In this study, we used BI and the BI loss index (the difference between pre-fracture BI and observed BI) to clarify the characteristics of each group's recovery transition. We also analyzed the outcomes at discharge using the BI loss index and explored the factors affecting variance.
Method: The necessary data was extracted from 286 patients in the regional cooperation path for proximal femur fracture registered from January 1, 2018 to December 31, 2019. The BI loss transition was graphed for each classification, and the factors influencing the occurrence of variances were statistically examined.
Result: The BI recovery curve was slower in groups in which the independent criteria for dementia ranked Ⅱ or above. The BI loss index at discharge was also significantly greater in those groups compared to groups in which the independent criteria for dementiaranked Ⅰ or less (p<0.01). The value of the BI loss index in the variance group was greater than in the non-variance group at the first stage and the difference did not diminish until discharge. On the other hand, our study showed that half of the cases in the bedridden group (0<BI<40) had improved their ADLs above even their pre-fracture levels, though their recovery curves were mild.
Conclusion: The complications of dementia of rank Ⅱ and above had a negative impact on ADL recovery. Appropriate rehabilitation at an early stage is critical to the subsequent recovery of ADLs. Continued rehabilitation may improve Quality of Life (QOL).
