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Effects on Function and Mortality

Albert L. Siu, MD, MSPH; Joan D. Penrod, PhD; Kenneth S. Boockvar, MD, MS; Kenneth Koval, MD; Elton Strauss, MD; R. Sean Morrison, MD

Arch Intern Med. 2006;166:766-771.

Background  Few studies have examined the relationship between inpatient bed rest and functional outcomes. We examined how immobility is associated with function and mortality in patients with hip fracture.

Methods  We conducted a prospective cohort study of 532 patients 50 years and older, who were treated with surgery after hip fracture in 4 hospitals in New York. We collected information from hospital visits, medical records, and interviews. "Days of immobility" was defined as days until the patient moved out of bed beyond a chair. Follow-up was obtained on function (using the Functional Independence Measure) at 2 and 6 months and on survival at 6 months.

Results  Patients with hip fracture experienced an average of 5.2 days of immobility. Compared with patients with a longer duration of immobility (ie, at the 90th percentile) in adjusted analyses, patients at the 10th percentile of immobility had lower 6-month mortality (–5.4%; 95% confidence interval [CI], –10.9% to –1.0%) and better Functional Independence Measure score for locomotion (0.99 points; 95% CI, 0.3 to 1.7 points, with higher values indicating better function), but there was no significant difference in locomotion by 6 months (0.58 points; 95% CI, –0.3 to 1.4 points). The adverse association of immobility was strongest in patients using personal assistance or supervision with locomotion at baseline (difference in 6-month mortality between the 90th and 10th percentile of immobility was –17.1% [P = .004] for this group and only 1.2% [P = .38] for patients independent in locomotion at baseline).

Conclusion  In patients with hip fracture, delay in getting the patient out of bed is associated with poor function at 2 months and worsened 6-month survival.

Author Affiliations: Mount Sinai School of Medicine, New York, NY (Drs Siu, Penrod, Boockvar, Strauss, and Morrison); Bronx New York Harbor VA Geriatric Research, Education, and Clinical Center, Bronx (Drs Siu, Penrod, Boockvar, and Morrison); Dartmouth Medical School, Hanover, NH (Dr Koval); and Hospital for Joint Diseases, New York (Dr Koval).

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