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Association between additional weekend rehabilitation and functional outcomes in patients with hip fractures: does age affect the effectiveness of weekend rehabilitation?

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Key summary points

AbstractSection Aim

To investigate the association between additional weekend rehabilitation and functional outcomes among different age groups.

AbstractSection Findings

After matching 129,583 pairs of cases, a significantly higher correlation was found between patients who had received weekend rehabilitation and improved physical function at discharge compared with those who had not received weekend regarding function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15–1.19], 1.17 [1.15–1.2], and 1.06 [1.03–1.08], respectively).

AbstractSection Message

Weekend rehabilitation was significantly associated with improved physical function; to optimise rehabilitation therapy given limited healthcare resources, low demand activities can be more effective in older age groups, whereas high demand activities should be aimed at younger age groups.

Abstract

Purpose

Rehabilitation after hip fracture surgery is crucial for improving physical function. Additional rehabilitation over the weekend or after working hours is reportedly associated with improved physical function; however, this may not apply to an aging population, including patients aged > 90 years. This study aimed to investigate the association between additional weekend rehabilitation and functional outcomes in different age groups.

Methods

This study analyzed a cohort of patients aged ≥ 60 years who had hip fractures and were operated on from 2010 to 2018. Data were extracted from a nationwide multicentre database. Functional outcomes at discharge were compared between patients who underwent rehabilitation on weekdays only and those who underwent rehabilitation on both weekdays and weekends. The patient groups were selected using propensity score matching analysis. Furthermore, a subgroup-analysis was conducted on patients in their 60 s, 70 s, 80 s, and 90 s.

Results

A total of 390,713 patients underwent surgery during the study period. After matching, each group comprised 129,583 pairs of patients. Patients who underwent weekend rehabilitation exhibited improved physical function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15–1.19], 1.17 [1.15–1.2], and 1.06 [1.03–1.08], respectively). In subgroup analysis, except for stair climbing, the positive association between weekend rehabilitation and patient function was observed across all age groups.

Conclusion

Weekend rehabilitation was significantly associated with improved physical function. Given the limited healthcare resources, high-demand activities such as stair climbing may be reserved for younger age groups to optimise rehabilitation therapy.

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Data availability

The Diagnosis Procedure Combination (DPC) database cannot be made available to comply with data governance agreements with the respective management authorities. The data can only be obtained through applications to authorised research institutions.

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Funding

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Author information

Author notes

  1. Takahisa Ogawa and Ryo Onuma equally contributed to the manuscript.

Authors and Affiliations

  1. Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan

    Takahisa Ogawa, Toshitaka Yoshii & Tetsuya Jinno

  2. Department of Rehabilitation, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan

    Ryo Onuma

  3. Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan

    Hiromori Sagae

  4. Division of Orthopaedic Surgery, Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Netanya, Israel

    Haggai Schermann

  5. Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Nielsine Nielsens Vej 10, 2400, Copenhagen NV, Denmark

    Morten Tange Kristensen

  6. Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan

    Kiyohide Fushimi

  7. Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan

    Tetsuya Jinno

  8. Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Ariel, Israel, Divrei Khayim St 16, 4244916, Netanya, Israel

    Haggai Schermann

  9. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Morten Tange Kristensen

Authors
  1. Takahisa Ogawa
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  7. Toshitaka Yoshii
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Contributions

The authors confirm their contributions to the paper as follows: study conception and design: TO, RO, and HS; data collection: KF; analysis and interpretation of results: TO, RO, HS, HS, and MTK; manuscript draft preparation: TO, RO, HS, HS, and MTK; supervision: MTK, TY, and TJ. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Tetsuya Jinno.

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Conflict of interest

The authors have no conflict of interest to declare. All authors have read and agreed to the published version of the manuscript.

Ethical review committee statement

The study protocol was approved by the institutional review boards of Tokyo Medical and Dental University (M2000-788-14).

Informed consent

This study was approved by the institutional review board (M2000-788), and the requirement for the acquisition of informed consent from individual patients was waived because the data were anonymised.

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Ogawa, T., Onuma, R., Sagae, H. et al. Association between additional weekend rehabilitation and functional outcomes in patients with hip fractures: does age affect the effectiveness of weekend rehabilitation?. Eur Geriatr Med (2024). https://doi.org/10.1007/s41999-024-00980-5

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