Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People

Figures

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  Fig. 1.. Flow diagram depicting patient selection criteria.

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  Fig. 2.. Cutoff value of MMSE for ≥70 points of mFIM at discharge. Receiver operating characteristic curve to identify the cutoff value of MMSE for acquiring ≥70 points of mFIM at hospital discharge. The area under the curve and 95% confidence interval were calculated as the overall discriminative ability of MMSE.

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  Fig. 3.. The relationships between variables used in the single and multiple regression analyses. Broken lines indicate the cutoff point of final mFIM and MMSE values. The regression lines are depicted in each graph. (A) MMSE (= x) vs. final mFIM (= y); the regression equation was as follows: (Final mFIM) = 2.11 × MMSE + 24.67. n = number of patients within the subgroup divided by these cutoff values. The chi-square test revealed a significant difference among these subgroups (P < 0.001). (B) Preinjury mFIM (= w) vs. final mFIM (= y). The dotted line “y = w” indicates that patients regained the preinjury ADL level at hospital discharge. Regression equation: (Final mFIM) = 1.34 × (Preinjury mFIM) – 44.72. (C) MMSE (= x) vs. mFIM efficiency (acute + recovery phase) (= z). The mFIM efficiency was defined as follows: (acute+recovery-mFIM efficiency) = {(mFIM scores at the final mFIM assessment) – (mFIM scores at the time of initial rehabilitation in the perioperative period)} / (time between the two time points) (points/day). Regression equation: (acute+recovery-mFIM efficiency) = 0.04 × MMSE + 0.04. The adjusted R2 was 0.181. (D) Preinjury mFIM (= w) vs. mFIM efficiency (acute + recovery…

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  Fig. 4.. Serial mFIM changes according to MMSE levels. (A, B) Patients were divided by MMSE scores (≥21 or ≤20). (A) mFIM scores were assessed at different periods: preinjury (= p, before the fracture), 1st (= f, at the time of initial rehabilitation in the perioperative period), 2nd (= s, at the start of recovery-phase rehabilitation 2–3 weeks postoperatively), and final (= d, at the time of hospital discharge). (B) mFIM gain scores were calculated by subtracting the serial mFIM scores as indicated: overall = d − p, initial loss = f − p, acute = s − f, recovery = d − s. (C, D) Shown are the scatter plots of mFIM efficiency (z) vs. MMSE (x). (C) The mFIM efficiency (acute phase) was defined as follows: (acute-mFIM efficiency) = (mFIM gain scores between f and s) / (time between f and s) (points/day). (D) The mFIM efficiency (recovery phase) is shown: (recovery-mFIM efficiency) = (mFIM gain scores between s and d) / (time between s and d) (points/day). *P < 0.05, **P < 0.01, and N.S. = not significant, by Mann–Whitney U test.

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  Supplemental Fig. 1.. (A) MMSE (= x) vs. time[1st-final] (= v). The regression coefficient of the MMSE for the time[1st-final] was 0.31 (95% confidence interval: −0.22, 0.85), and the adjusted R2 was 0.004. (B) Time[1st-final] (= v) vs. final mFIM (= y). The regression coefficient of time[1st-final] for the final mFIM was 0.11 (95% confidence interval: −0.12, 0.33), and the adjusted R2 was −0.001. Time[1st-final] is the time between initial rehabilitation in the perioperative period and the final mFIM assessment before hospital discharge.

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  Supplemental Fig. 2.. mFIM efficiency according to preinjury mFIM levels. Scatter plots of mFIM efficiency (z) vs. preinjury mFIM (w) are shown. (A) The mFIM efficiency (acute phase) was defined as follows: (acute-mFIM efficiency) = (mFIM gain scores between f and s) / (time between f and s) (points/day). (B) The mFIM efficiency (recovery phase): (recovery-mFIM efficiency) = (mFIM gain scores between s and d) / (time between s and d) (points/day). f = time point of initial rehabilitation in the perioperative period, s = time point of the mFIM assessment at the starting of recovery-phase rehabilitation 2–3 weeks postoperatively, d = time point of the final mFIM assessment before the hospital discharge.