Towards better hip fracture rehabilitation: Modifiable and non-modifiable factors – policy implications

OBJECTIVE: To investigate relationships between patient characteristics, length of stay (LOS) and functional improvement among rehabilitation patients following hip fracture, utilizing data from Israel's National Program for Quality Indicators. DESIGN: Nationwide retrospective cohort study (2016-2019) analyzing admission and discharge Functional Independence Measure (FIM) scores. PARTICIPANTS: Population-based sample (N=13,161) of patients aged ≥65 who underwent institutional rehabilitation after hip fracture between 2016 and 2019. MAIN OUTCOME MEASURE: FIM gain and rehabilitation efficiency, calculated from FIM scores. The analysis focused on how these outcomes were influenced by patient age, gender, initial FIM scores, LOS, and type of rehabilitation setting. RESULTS: FIM gain showed a significant inverse correlation with patient age and very high or very low admission FIM scores. A positive correlation was found between LOS and FIM gain, with slope moderation beyond 20 days. Multivariate analysis identified significant effects of age, gender, initial FIM score, and LOS on FIM gain (all p<.001). CONCLUSIONS: Functional improvement, as measured by FIM gain, is influenced by various factors. Current large-scale, long-term national study demonstrates that in prolonged hospitalizations (>20 days), the improvement associated with extending the LOS is smaller than the improvement associated with extending LOS in shorter hospitalizations (<20 days). These findings can help guide nursing care plans, resource allocation, patient referral and policy adjustments. Further research is needed to validate those findings.