Monday, Nov 3
Melvin Stephens, Estimating Program Benefits
Tseng, M., Y. Shyu, and Jersey Liang. 2012. "Functional Recovery of Older Hip-Fracture Patients After Interdisciplinary Intervention Follows Three Distinct Trajectories." Gerontologist, 52(6): 833-842.
Purpose To assess the effects of an interdisciplinary intervention on the trajectories of functional recovery among older patients with hip fracture during 2 years after hospitalization. Design and Methods In a randomized controlled trial with 24-month follow-up, 162 patients > 60 years were enrolled after hip-fracture surgery at a 3,000-bed medical center in northern Taiwan. Patients received an interdisciplinary program of geriatric consultation, in-hospital and at-home rehabilitation, and discharge planning (n = 80) or usual care (n = 82). Patients' functional status was assessed by the Chinese Barthel Index before discharge and at 1, 3, 6, 12, 18, and 24 months after discharge. Covariates included demographic attributes, depressive symptoms, and cognitive functioning. Latent class growth modeling was used to examine distinctive groups of individual trajectories within the sample. Results Functional recovery followed 3 distinct paths, approximated by either a quadratic or cubic function over time. These paths were (a) poor recovery (6.8%), (b) moderate recovery (47.5%), and (c) excellent recovery (45.7%). The interdisciplinary intervention significantly reduced the likelihood of poor recovery (relative risk ratio [RRR] = 0.05, p < .01) and moderate recovery (RRR = 0.17, p < .01), relative to excellent recovery. In addition, the major risk factors for poor or moderate recovery were older age, lower prefracture physical functioning, as well as higher depression scores and lower cognitive functioning before discharge. Implications Distinct trajectories of functional recovery can serve as useful outcome measures in clinical research and practice.