Nav: Home

Study finds association between therapy time, length of stay after hip fracture surgery

January 27, 2020

WASHINGTON (Jan. 27, 2020) -- The rate of recovery and a patient's length of stay at nursing and rehabilitation facilities are associated with a patient's mobility and their ability to provide self-care when they are discharged following hip fracture surgery, according to a new study from the George Washington University (GW), published in JAMA Network Open.

The authors of the study suggest that a care team should prioritize identifying a patient's recovery trajectory early enough in care to promote the best possible outcomes and allocate resources efficiently.

Medicare is shifting from payment for post-acute care services based on the volume provided to a payment system based on value as determined by patient characteristics and functional outcomes, placing responsibility on facilities to determine what a patient's care will entail. Nursing and rehabilitation facilities are responsible for ensuring that a patient's therapy time and length of stay match their needs. This formula of appropriate patient care matched with patient needs is critical to optimizing functional outcomes and manage costs of rehabilitation.

"This study is very timely," said Alison Cogan, PhD, OTR/L, adjunct assistant professor of health, human function, and rehabilitation sciences at the GW School of Medicine and Health Sciences (SMHS) and first author on the study. "There is a lot of pressure to be cost effective in clinical care across the board and maintain appropriate rehabilitation time for patients."

The researchers provided a retrospective analysis of data on patients from four inpatient rehabilitation facilities and seven skilled nursing facilities in the United States who received rehabilitation services for hip fracture and who had Medicare fee-for-service as their primary payer. The team categorized the patients into nine recovery groups based on low, medium, and high therapy minutes per day and low, medium, or high rate of functional gain per day. They measured the groups for functional mobility independence and self-care capabilities at the time each patient was discharged.

Cogan and the team found that rate of recovery and length of stay in skilled nursing and rehabilitation facilities were associated with mobility and self-care outcomes at discharge following hip fracture surgery. In particular, the authors found that for medium gain patients, being discharged from a facility in under 21 days may transfer additional the burden of care to family and caregivers, home health, and outpatient services, because these patients typically achieve functional independence at around 28 days in rehab.

"The inclination is typically to give a patient more therapy per day," said Trudy Mallinson, PhD, associate dean for health sciences research at SMHS, director of the Advanced Metrics Lab, where the study was produced, and senior author of the study. "But perhaps more isn't always the right thing to do. Maybe a longer stay is the right thing for some patients.

"This study is a first step. It's a way to start thinking about how we can help clinicians, patients, and caregivers think about what amount of therapy is appropriate for each patient's unique situation."

The next steps, according to the team, are to study with a larger national sample and also to apply the same methodology to other questions for patients with other conditions requiring rehabilitation services, such as stroke and joint replacement.
The study, titled "Association of Length of Stay, Recovery Rate, and Therapy Time per Day with Functional Outcomes After Hip Fracture Surgery," is published in JAMA Network Open at

George Washington University

Related Hip Fracture Articles:

Hip fracture risk linked to nanoscale bone inflexibility
New research has highlighted a preventative treatment gap in patients prone to bone fractures who are otherwise healthy.
Study seeks to explain decline in hip fracture rates
In a paper published in the Journal of the American Medical Association Internal Medicine today, researchers showed how analysis of data from the multigenerational Framingham Osteoporosis Study may in part explain why the incidence of hip fracture in the US has declined during the last two decades.
'Remarkably high' rate of suicide among elderly patients after hip fracture
Older adults who suffer a hip fracture requiring surgery are at a higher risk of suicide, suggests a study in the June 17, 2020 issue of The Journal of Bone & Joint Surgery.
Low physical function increase the risk for bone loss in older hip fracture patients
Low physical function and low muscle mass after hip fracture increased the risk for accelerated bone deterioration in older hip fracture patients.
Study reports nursing home hip fracture rates stay persistently high
A recent study of hip fracture rates in nursing homes in the U.S. reports a slight rise in the rate of hip fractures among long-stay residents in recent years.
Vitamin D boosts chances of walking after hip fracture
Senior citizens who are not vitamin D deficient have a better chance of walking after hip fracture surgery, according to a Rutgers-led study.
Does tramadol increase hip fracture risk?
An analysis published in the Journal of Bone and Mineral Research reveals that use of the pain medication tramadol was linked with a higher risk of hip fractures compared with the use of other pain medications in an analysis of a patient database from the United Kingdom.
Study finds association between therapy time, length of stay after hip fracture surgery
Researchers in the George Washington University Advanced Metrics Lab found that a hip fracture patient's length of stay in a rehabilitation facility has a greater impact on functional independence than therapy time per day
Multicomponent home-based treatments improve mobility in older adults after hip fracture
Each year more than 260,000 older Americans are hospitalized for hip fractures, a debilitating injury that can severely and permanently impact mobility.
Excellence payments to hospitals improve hip fracture care
A scheme that pays hospitals to deliver high quality care has been shown to improve the outcomes for patients with broken hips in England.
More Hip Fracture News and Hip Fracture Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at     You can read The Transition Integrity Project's report here.