Factors influencing initial rehabilitation type after hip fracture surgery: a retrospective cohort study

Objective — To describe and compare the factors that impact initial rehabilitation type after hip fracture surgery.

Design — Retrospective population-based cohort study.

Setting and participants — People aged between 50 and 105 with a hip fracture who had a surgical repair in Ontario, Canada, between January 1, 2015, and December 31, 2021.

Methods —Descriptive statistics and a multinomial logistic regression model were used to identify factors associated with initial rehabilitation type.

Results — In this study, 63,401 individuals were included with a mean age of 80 years (standard deviation [SD] 10.9), mostly female (67.3%), with 86.3% living in urban areas at the time of hospitalization and most (72.6%) admitted from the community without home care. A total of 24.5% of individuals did not receive any form of rehabilitation. Rurality of residence decreased the odds of having an initial rehabilitation type in complex continuing care (odds ratio [OR], 0.23; 95% CI, 0.21–0.26), in inpatient rehabilitation (OR, 0.26; 95% CI, 0.24–0.28), or in community rehabilitation (OR, 0.54; 95% CI, 0.50–0.58) compared with no rehabilitation. Dementia decreased the odds of having an initial rehabilitation type in complex continuing care (OR, 0.75; 95% CI, 0.69–0.81), in inpatient rehabilitation (OR, 0.44; 95% CI, 0.41–0.47), or in community rehabilitation (OR, 0.88; 95% CI, 0.82–0.95) compared with receiving no rehabilitation. Previous history of fragility fracture decreased the odds of having an initial rehabilitation type in either complex continuing care (OR, 0.30; 95% CI, 0.27–0.34), in inpatient rehabilitation (OR, 0.27; 95% CI, 0.24–0.29), or in community rehabilitation (OR, 0.33; 95% CI, 0.30–0.37) compared with no rehabilitation.

Conclusions and implications — Rurality of residence, dementia, and previous history of fragility fractures reduced the odds of receiving specialized inpatient rehabilitation and increased the odds of receiving no rehabilitation. Future research should focus on achieving more equitable care for individuals living in rural settings, with dementia, or with previous fragility fractures to enhance the quality of care and achieve best outcomes for the overall hip fracture population.