ระยะเวลาและปัจจัยที่เกี่ยวข้องกับการบรรลุความเป็นอิสระในผู้ป่วยกระดูกสะโพกหัก ภายใต้การฟื้นฟูสมรรถภาพระยะกลางในจังหวัดร้อยเอ็ด

Kittima  Duangduen

Authors

Kittima Duangduen Roi Et Hospital

Keywords:

Intermediate Care, Fragility Hip Fracture, Rehabilitation Outcomes, Time to Functional Independence, Complications, Mortality

Abstract

Purposes: To investigate rehabilitation outcomes, time to functional independence in activities of daily living and mobility, associated factors, complications, and mortality within six months among patients with fragility hip fracture receiving Intermediate Care rehabilitation.

Study design: Retrospective cohort study.

Materials and Methods: A total of 147 patients aged 50 years and older with fragility hip fracture who received Intermediate Care rehabilitation in hospitals in Roi Et Province were included. Changes in the Modified Barthel Index and the mobility domain of the Modified Barthel Index before and after rehabilitation were analyzed. Factors associated with functional independence and time to functional independence were evaluated. Statistical significance was set at p < .05.

Main findings: The mean age of the participants was 77.9 ± 8.6 years, and 79.6% were female. Both the Modified Barthel Index and mobility scores improved significantly after rehabilitation (p < .001). Within six months, 52.4% of patients achieved independence in activities of daily living, and 66.0% achieved independent mobility. The median time to independent mobility and independence in activities of daily living was 107 and 161 days, respectively. Older age was associated with a lower likelihood of achieving functional independence and a longer time to achieve independence in activities of daily living. In contrast, patients who were able to bear weight after treatment were more likely to achieve functional independence and reached these outcomes in a shorter period of time. The six-month complication and mortality rates were 8.8% and 5.4%, respectively, and no factors were significantly associated with complications or mortality.

Conclusion and recommendations: Intermediate Care rehabilitation significantly improved activities of daily living and mobility among patients with fragility hip fracture. Independent mobility was achieved earlier than independence in activities of daily living. Older age was associated with poorer recovery, whereas the ability to bear weight after treatment was associated with better outcomes and faster recovery. Continuous rehabilitation and appropriate weight-bearing, when medically indicated, should be encouraged to optimize functional outcomes.

References

Dyer S M, Crotty M, Fairhall N, Magaziner J, Beaupre L A, Cameron I D, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16:158.

Haentjens P, Magaziner J, Colón-Emeric C S, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: Excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380-90.

Pedersen T J, Lauritsen J M. Routine functional assessment for hip fracture patients. Acta Orthop. 2016;87(4):374-9.

Lee S W, Elsakr C, Joung K M, Ayutyanont N. Outcomes after inpatient rehabilitation for older adults with hip fractures: A cross-sectional study. Clin Rehabil. 2025;39(1):35-46.

สำนักอนามัยผู้สูงอายุ กรมอนามัย กระทรวงสาธารณสุข. คู่มือแนวทางปฏิบัติการฟื้นฟูสมรรถภาพ ผู้ป่วยสูงอายุระยะกลาง (Guideline for Intermediate Care in the elderly) [อินเทอร์เน็ต]. นนทบุรี: กรมอนามัย; 2563. [เข้าถึงเมื่อ 28 ธันวาคม 2568]. เข้าถึงได้จาก: https://sgh.go.th/uploads/Y65-Manual02.pdf

สถาบันสิรินธรเพื่อการฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ. คู่มือการฟื้นฟูสมรรถภาพผู้ป่วยระยะกลาง: Guideline for Intermediate Care สำหรับบุคลากรทางการแพทย์ ตามแผนพัฒนาระบบบริการสุขภาพ (Service Plan) ฉบับปรับปรุง พ.ศ. 2567. นนทบุรี: สถาบันสิรินธรเพื่อการฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ; 2567.

Clancy U, Brown M, Alio Z, Wardle K, Pendleton N. Older people with hip fracture transferred to intermediate care: outcomes in an integrated health and social care model. Future Healthc J. 2018;5(1):58-63.

Fairhall N J, Dyer S M, Mak J C, Diong J, Kwok W S, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2022;9(9):CD001704.

Tanaka R, Umehara T, Fujimura T, Ozawa J. Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months After Surgery for Hip Fracture Repair. Arch Phys Med Rehabil. 2016;97(12):2076-84.

Lim S K, Beom J, Lee S Y, Lim J Y. Functional Outcomes of Fragility Fracture Integrated Rehabilitation Management in Sarcopenic Patients after Hip Fracture Surgery and Predictors of Independent Ambulation. J Nutr Health Aging. 2019;23(10):1034-42.

Kang M J, Kim B R, Lee S Y, Beom J, Choi J H, Lim J Y. Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study. Medicine (Baltimore). 2023;102(7):e32909.

Handoll H H, Cameron I D, Mak J C, Panagoda C E, Finnegan T P. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2021;11(11):CD007125.

Roobsoong A, Permyao J, Chantiratikul S. Clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project between the regional and district hospitals in Chiang Rai province: preliminary comparative results. Journal of Health Systems Research. 2020;14(1):88-100.

Thaweechotiphat C. Outcomes of intermediate phase fragility hip fracture patient rehabilitation in Samphran Hospital. Maharaj Nakhon Si Thammarat Medical Journal. 2025;8(2):39-52.

Boonpitak J. Outcomes of intermediate phase after hip fracture rehabilitation and factors associated with gait recovery at Lampang Hospital. Chiangrai Medical Journal. 2025;17(1):75-86.

Tangsiriamnauy W. Intermediate care beds vs. intermediate care wards: a comparison in hip fracture patients. Region 4-5 Medical Journal. 2025;44(2):155-68.

Beckmann M, Bruun-Olsen V, Pripp A H, Bergland A, Smith T, Heiberg KE. Recovery and prediction of physical function 1 year following hip fracture. Physiother Res Int. 2022;27(3):e1947.

Selaković I, Mandić-Rajčević S, Milovanović A, Tomanović-Vujadinović S, Dimitrijević S, Aleksić M, et al. Pre-Fracture Functional Status and Early Functional Recovery are Significant Predictors of Instrumental Activities of Daily Living After Hip Fracture: A Prospective Cohort Study. Geriatr Orthop Surg Rehabil. 2024;15:21514593241255627.

Daraphongsataporn N, Saloa S, Sriruanthong K, Philawuth N, Waiwattana K, Chonyuen P, Pimolbutr K, Sucharitpongpan W. One-year mortality rate after fragility hip fractures and associated risk in Nan, Thailand. Osteoporos Sarcopenia. 2020;6(2):65-70.

Chongmuenwai A, Silathong P, Rattanakitkoson T, Sukpongthai T, Permthongchoochai N. Factors affecting postoperative functional outcomes in older patients with hip fractures at a large public hospital in Thailand. J Southeast Asian Orthop. 2023;47(2):11-17.