The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study.

OBJECTIVE: To compare the predictive validity of trunk control in sitting position assessed by Trunk Impairment Scale and balance in lying, sitting and standing posture assessed by Postural Assessment Scale for Stroke patients on functional outcome in stroke survivors. DESIGN: Prospective observational study. SETTING: A single rehabilitation hospital in Italy. SUBJECTS: Sixty of 68 consecutive subjects admitted to a rehabilitation hospital after stroke. MAIN MEASURES: We performed Trunk Impairment Scale and Postural Assessment Scale for Stroke patients at admission to inpatient rehabilitation. Outcome measures at discharge were Functional Independence Measure score and destination (classified as either home or institution). RESULTS: After adjustment for 14 potential confounders, including Functional Independence Measure score at admission to rehabilitation, both Trunk Impairment Scale and Postural Assessment Scale for Stroke patients scores were significantly associated with the Functional Independence Measure score at discharge (P = 0.010 and P =0.04, respectively), change in the Functional Independence Measure score during rehabilitation (P = 0.003 and P<0.001, respectively), Functional Independence Measure effectiveness (P = 0.024 and P =0.017, respectively) and destination at discharge (P = 0.040 and P =0.032, respectively). The panel of prognostic variables predicted 64-65% of the variance in the final Functional Independence Measure score, 30-35% of the variance in the change of the Functional Independence Measure score during rehabilitation, and 45-46% of the variance in the Functional Independence Measure effectiveness depending on the inclusion of either Trunk Impairment Scale or Postural Assessment Scale for Stroke patients score among the predictors.

Type of hip fracture in patients with Parkinson disease is associated with femoral bone mineral density.

OBJECTIVE: To investigate the association between bone mineral density (BMD) and hip fracture type (cervical or trochanteric) in a sample of fallers with Parkinson disease (PD). DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PATIENTS: We investigated 1040 of 1120 white fallers consecutively admitted to a rehabilitation hospital for hip fracture. Thirty-eight (3.65%) of the 1040 patients suffered from PD secondarily. Thirty-eight controls matched for sex, age, and hip fracture type were found among the 1002 non-PD fallers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was assessed by dual-energy x-ray absorptiometry at a mean+/-SD of 21.9+/-7.5 days after fracture occurrence in the 38 PD patients and 21.6+/-5.9 days after fracture occurrence in the 38 controls. RESULTS: BMD assessed at total femur, trochanter, and intertrochanteric region was significantly lower in the 15 PD patients with trochanteric fractures than in the 23 with cervical fractures; the mean T score differences were 0.57 (95% confidence interval [CI], 0.07-1.08; P=.028), 0.66 (95% CI, 0.04-1.28; P=.037), and 0.63 (95% CI, 0.11-1.15; P=.019), respectively. A significant association between femoral BMD and hip fracture type was found at logistic regression after adjustment for several confounders. Results in the 38 controls were similar to those obtained in the 38 PD fallers. CONCLUSIONS: In a sample of PD fallers as in a control group of non-PD fallers, BMD levels assessed at 3 femoral sites were significantly lower in the patients who sustained trochanteric fractures than in those with cervical fractures of the hip.

A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a single home visit by an occupational therapist in the reduction of fall risk after hip fracture in elderly women. DESIGN: Quasi-randomized controlled trial. PARTICIPANTS: Ninety-five women aged 60 years or older, living in the community, who sustained a fall-related hip fracture. METHODS: The women were allocated alternately to intervention or control groups. All the women underwent a multidisciplinary programme targeted at fall prevention during in-patient rehabilitation. Additionally, the intervention group received a home visit by an occupational therapist a median of 20 days after discharge. Falls were recorded at a 6-month follow-up. RESULTS: Thirteen of the 50 women in the control group sustained 20 falls during 9231 days, whereas 6 of the 45 women in the intervention group sustained 9 falls during 8970 days. After adjustment for observation periods, Barthel Index scores, and body height, a significantly lower proportion of fallers was found in the intervention group: the odds ratio was 0.275 (95% confidence interval 0.081-0.937, p=0.039). CONCLUSION: A single home visit by an occupational therapist after discharge from a rehabilitation hospital significantly reduced the risk of falling in a sample of elderly women following hip fracture.

Fat mass and skeletal muscle mass in hip-fracture women: a cross-sectional study.

OBJECTIVES: To investigate the association between appendicular lean mass (aLM) and age, fat mass (FM), serum levels of Vitamin D, parathyroid hormone, three parameters of the protein nutritional status (total lymphocyte count, serum albumin, and insulin-like growth factor I), levels of independence in activities of daily living (assessed by using Barthel index scores), type both of hip fracture and surgical operation, number of medications in use, and number of concomitant diseases in hip-fracture women. METHODS: We investigated 299 of 327 hip-fracture women admitted consecutively to a rehabilitation hospital. Soft tissue body composition was assessed by dual-energy X-ray absorptiometry, 22.1+/-7.5 (mean+/-S.D.) days after fracture occurrence. Appendicular LM was calculated as the sum of LM in arms and legs. Because metal implants (prostheses and nails) affect the regional assessment of body composition, aLM was corrected by substituting LM in unfractured leg for LM in fractured leg: corrected aLM=(LM in unfractured leg x 2)+LM in arms. We divided corrected aLM by height squared (aLM/ht(2)), to adjust it for body size. RESULTS: Four variables were significantly correlated with corrected aLM: age, height, FM, and Barthel index score. FM was the only variable significantly correlated with aLM/ht(2) (r=0.492; p<0.001). This significant correlation was not affected after adjustment for age and Barthel index score. CONCLUSIONS: FM measured after hip fracture was significantly associated with aLM/ht(2) in women.

Peracetic acid in the disinfection of a hospital water system contaminated with Legionella species.

OBJECTIVE: To assess the efficacy of an alternative disinfection method for hospital water distribution systems contaminated with Legionella. METHODS: Disinfection with peracetic acid was performed in a small hospital contaminated with L. pneumophila serotype 1. The disinfectant was used at concentrations of 50 ppm (first three surveillance phases) and 1,000 ppm (fourth surveillance phase) for 30 minutes. RESULTS: Environmental monitoring revealed that disinfection was maintained 1 week after treatment; however, levels of recontamination surpassing baseline values were detected after approximately 1 month. Comparison of water temperatures measured at the distal outlets showed a statistically significant association between temperature and bacterial load. The circulating water temperature was found to be lower in the two wards farthest away from the hot water production plant than in other wards. It was thought that the lower water temperature in the two wards promoted the bacterial growth even after disinfection. CONCLUSION: Peracetic acid may be useful in emergency situations, but does not provide definitive protection even if used monthly.

Functional recovery after concomitant fractures of both hip and upper limb in elderly people.

OBJECTIVE: To investigate functional recovery after concomitant fractures of both hip and upper limb in elderly people. DESIGN: Survey study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: 586 consecutive in-patients with hip fracture. MAIN OUTCOME MEASURES: Functional recovery was evaluated by using Barthel index score. RESULTS: 4.1% of patients (i.e. 24/586) suffered from a concomitant fracture of an upper limb, involving proximal humerus (n = 8) or distal radius (n = 16). After adjustment for 9 prognostic factors, a significant reduction in the Barthel index score on admission but not on discharge was found in the patients with an upper limb fracture. The length of stay was not significantly associated with the presence of the concomitant upper limb fracture. CONCLUSIONS: In a sample of hip-fractured patients, neither the functional recovery at the end of a course of rehabilitation nor the length of stay were influenced by the presence of a concomitant fracture involving an upper limb.

Serum levels of insulin-like growth factor-I are positively associated with functional outcome after hip fracture in elderly women.

OBJECTIVE: To investigate the association between serum levels of insulin-like growth factor-I (IGF-I) and functional outcome in hip-fracture women. DESIGN: We investigated 171 of 188 women admitted consecutively to a rehabilitation hospital after hip fracture. IGF-I serum levels were assessed by using an automated chemiluminescence immunoassay 21.3 +/- 6.1 days (mean +/- SD) after fracture occurrence. Functional outcome was assessed using Barthel index scores. RESULTS: At a Spearman rank test we observed a significant positive correlation between IGF-I levels and both Barthel index scores at discharge from inpatient rehabilitation (rho = 0.213; P = 0.005) and changes in Barthel index scores during rehabilitation (rho = 0.222; P = 0.004). At multiple regression, a significant association between IGF-I and both functional scores and their changes during rehabilitation was found after adjustment for several potential confounders, including age, cognitive impairment, pressure ulcers, neurologic impairment, infections, Barthel index score at admission to rehabilitation, and length of stay in hospital (P < 0.05). Overall, the panel of prognostic factors accounted for 55% of the variance in the functional score and 31% of the variance in its change during rehabilitation. CONCLUSIONS: IGF-I serum levels were significantly associated with ability to function after hip fracture in women.

Incident falls impair ability to function in hip-fracture survivors: a prospective study of 95 elderly women.

The present study focused on home-dwelling women successfully discharged back to the community after a fall-related fracture of the hip. We investigated the role of incident falls in affecting ability to function in activities of daily living. Ninety-five of 103 consecutive women without cognitive impairment were recruited during in-patient rehabilitation following their first hip fracture. Functional independence in activities of daily living was assessed by using the Barthel Index (BI) score at discharge from in-patient rehabilitation and at a 6-month follow-up. Nineteen of the 95 women sustained one or more falls during a median observation time of 187 days. At a Mann-Whitney test, both BI scores assessed at the 6-month follow-up and gains in BI scores during the follow-up were significantly lower in the 19 fallers than in the 76 non-fallers (p=0.021 and p=0.030, respectively), whereas no significant differences were found in baseline BI scores between the two groups. At linear multiple regression, we found a negative association between incident falls and both functional scores (p=0.01) and their gains (p=0.006) after adjustment for several confounders. We conclude that incident falls were significantly associated with a worse functional score in our sample of hip-fracture women.

Muscle mass and functional recovery in men with hip fracture.

OBJECTIVE: To investigate the association between muscle mass and functional recovery in men after hip fracture. DESIGN: We investigated 27 of 33 men admitted consecutively to a rehabilitation hospital after hip fracture. For each patient, we also studied two control women, matched for age and fracture type. Lean mass (LM) was assessed by dual-energy x-ray absorptiometry (DXA) 21.9 +/- 7.5 (mean +/- SD) days after fracture occurrence in the 27 men (22.8 +/- 7.2 days in the 54 control women). Appendicular LM (aLM) was calculated as the sum of LM in arms and legs. Functional recovery was assessed using Barthel index scores. Barthel index efficiency was calculated as the change in the Barthel index score after rehabilitation divided by the length of stay in hospital. RESULTS: After adjustment for age, height, fat mass, Barthel index scores at admission, and time between fracture occurrence and DXA assessment, aLM was significantly associated with Barthel index scores after rehabilitation (r = 0.480; P = 0.013) and Barthel index efficiency (r = 0.633; P = 0.001) in the 27 men. Conversely, in the 54 control women, no significant associations were found between aLM and the functional scores. CONCLUSIONS: LM assessed after hip fracture is significantly associated with the functional outcome in men.

Skeletal muscle mass, fat mass, and hip bone mineral density in elderly women with hip fracture.

Soft tissue body composition strongly affects bone health. Our aim was to investigate the relationship between both skeletal muscle mass (SMM) and fat mass (FM) and femoral bone mineral density (BMD) in a sample of elderly women with hip fracture. We assessed 293 of 325 hip fracture women admitted consecutively to a rehabilitation hospital. Soft tissue body composition and BMD were assessed by dual-energy X-ray absorptiometry (DXA), 23.2 +/- 7.7 (mean +/- SD) days after fracture occurrence. BMD was measured at four sites (neck, total femur, trochanter, intertrochanteric area) in the unfractured femur. Appendicular lean mass (aLM) was calculated as the sum of LM in arms and legs. We used two approaches to adjust aLM for body size: aLM divided by height squared (aLM/ht(2)), and aLM adjusted for height and FM (residuals). Both FM and aLM were significantly correlated with femoral BMD. However, the correlation coefficients for aLM were lower than for FM; they further decreased after adjustment for height squared, and were no longer significant after correction for both height and FM (residuals). When FM, aLM/ht(2), age, and time spent between fracture occurrence and DXA assessment were included together as the independent variables in a regression model, FM was the only independent variable significantly associated with BMD. The coefficients of partial correlation ranged from 0.414 to 0.647 depending on the femoral region of BMD assessment (P < 0.001). FM, but not SMM emerged as a pivotal determinant of BMD in our sample of hip fracture women.

Muscle mass and functional recovery in women with hip fracture.

OBJECTIVE: To investigate the association between muscle mass and functional recovery in women with hip fracture. DESIGN: A total of 200 of 230 women with hip fracture admitted consecutively to a rehabilitation hospital were investigated in this survey study. Lean mass (LM) was assessed by dual-energy x-ray absorptiometry, 23.1 +/- 7.9 (mean +/- SD) days after fracture occurrence. Appendicular LM (aLM) was calculated as the sum of LM in arms and legs. Because metal implants (prostheses and nails) affect the regional assessment of body composition, aLM was corrected by substituting LM in the unfractured leg for LM in the fractured leg: corrected aLM = (LM in unfractured leg x 2) + LM in arms. We used two approaches to adjust corrected aLM for body size: corrected aLM divided by height squared (aLM/ht), and corrected aLM adjusted for height and fat mass (residuals). Functional recovery was assessed by using Barthel index scores. RESULTS: After adjustment for body size, corrected aLM was neither significantly correlated with Barthel index scores nor with the change in Barthel index scores after rehabilitation. Also, after stratification for quintiles of aLM/ht and residuals, no significant differences in functional recovery were found among the five groups. CONCLUSIONS: LM assessed after hip fracture is not associated with functional outcome in women.

Body mass index and functional recovery after hip fracture: a survey study of 510 women.

BACKGROUND AND AIMS: Low body mass index (BMI) is associated with high risk of osteoporosis and fractures, but its impact on functional recovery after fractures is unknown. Our aim was to investigate the association between BMI and both functional recovery and period of rehabilitation in hip-fractured women. METHODS: 510 out of 580 Caucasian women with hip fracture, admitted consecutively to a rehabilitation hospital, were investigated in this retrospective study. Functional recovery was assessed using the Barthel index score. RESULTS: In the 510 women, BMI was 22.8 +/- 4.1 kg/m2 (mean +/- SD). After adjustment for age, femur bone mineral density, and the Barthel index assessed on admission to rehabilitation, a significant negative association was found between BMI and both the Barthel index score after rehabilitation and changes in it resulting from rehabilitation (p < 0.001). After adjustment for age and the Barthel index assessed on admission to rehabilitation, a significant positive association was found between BMI and period of rehabilitation (p < 0.001). The results were similar when BMI was evaluated either as individual values or after categorization according to World Health Organization criteria. CONCLUSIONS: In a sample of hip-fractured women, BMI was negatively associated with Barthel index scores and positively associated with period of rehabilitation. BMI may affect function after hip fracture, apart from hip fracture risk: subjects with higher BMI and low hip fracture risk may have poorer functional recovery in case of hip fracture, despite prolonged rehabilitation. Conversely, subjects with lower BMI and high hip fracture risk may have better functional recovery in case of hip fracture.

Bone mineral density in hip-fracture patients with Parkinson's disease: a case-control study.

OBJECTIVE: To investigate bone mineral density (BMD) levels in patients with Parkinson's disease (PD) who sustained a hip fracture. DESIGN: Case-control study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated 831 out of 887 white patients consecutively admitted to a rehabilitation hospital because of an original hip fracture resulting from a fall. Twenty-eight (3.37%) of the 831 patients were affected by PD. Twenty-eight controls matched for sex, age, and hip-fracture type (cervical or trochanteric) were found among the 803 non-PD patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was assessed by dual-energy x-ray absorptiometry (DXA) at the unfractured femur. Five sites were investigated in each subject: total proximal femur, femoral neck, trochanter, intertrochanteric area, and Ward's triangle. DXA scan was performed a mean +/- standard deviation of 22.2 +/- 7.8 days after fracture occurrence in the 28 patients and 22.0 +/- 5.3 days after fracture occurrence in the 28 controls. RESULTS: BMD expressed as a T score did not differ significantly between the 28 PD patients and the 28 controls, whereas z score in the PD patients was significantly lower than 0 +/- 1 in the age- and sex-matched general population at 4 of the 5 sites of BMD assessment. CONCLUSIONS: A sample of PD fallers who sustained a hip fracture had femoral BMD levels similar to those found in matched hip-fracture fallers who did not suffer from PD and significantly lower than those found in the matched reference population.

25-hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients.

There is increasing interest in the effects of vitamin D and parathyroid hormone (PTH) on extraskeletal tissues, including the muscle. These effects may explain impairment in functional ability found in vitamin D-deficient subjects. Our aim was to investigate the roles of vitamin D and PTH in affecting the ability to perform activities of daily living after hip fracture. We studied 456 of 521 hip-fracture patients admitted consecutively to a rehabilitation hospital. Functional outcome was assessed after acute inpatient rehabilitation by using the Barthel index score. The functional scores were significantly correlated with serum levels of 25-hydroxyvitamin D (rho = 0.190; P < 0.001) and PTH (rho = -0.164; P < 0.001) and the 25-hydroxyvitamin D/PTH ratio (rho = 0.261; P < 0.001). At multiple regression, 25-hydroxyvitamin D and PTH levels were independently associated with Barthel index scores. The correlation between the 25-hydroxyvitamin D/PTH ratio and Barthel index scores was significantly stronger than the one between 25-hydroxyvitamin D and Barthel index scores (difference between the two correlation coefficients = 0.071; 95% CI = 0.009-0.133; P = 0.011). The significant association between the 25-hydroxyvitamin D/PTH ratio and the Barthel index scores persisted after adjustment for 12 prognostic factors (P = 0.012). On the whole, the panel of prognostic factors we studied predicted 50.1% of the variance of the functional score. Data shows that PTH and 25-hydroxyvitamin D were significantly associated with the ability to function after hip fracture and suggest that the two hormones act through independent mechanisms. The 25-hydroxyvitamin D/PTH ratio significantly contributed to a predictive model of functional outcome.

Serum levels of 25-hydroxyvitamin D and functional recovery after hip fracture.

OBJECTIVE: To evaluate the association between serum levels of 25-hydroxyvitamin D (25[OH]D(3)) and functional recovery after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: A total of 350 white hip-fracture patients consecutively admitted to a rehabilitation hospital. Thirty-five patients were excluded because their hip fracture was caused by major trauma or cancer affecting the bone or they could not complete rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients underwent 25(OH)D(3) assessment at a mean +/- standard deviation of 21.3+/-8.1 days after the hip fracture. Functional recovery was evaluated by using Barthel Index scores. RESULTS: Low levels of 25(OH)D(3) were found (median, 6.9 ng/mL). By using the Spearman rank correlation test, a significant positive correlation was observed between serum 25(OH)D(3) and Barthel Index score assessed on admission (rho=.218, P <.001) and discharge (rho=.198, P <.001), but not with the change in Barthel Index score attributable to rehabilitation. Linear multiple regression showed that the association between 25(OH)D(3) and Barthel Index score was independent of 11 confounding variables: age, sex, hip-fracture type, pressure ulcers, cognitive impairment, neurologic impairment, infections, time between fracture occurrence and 25(OH)D(3) evaluation, comorbidity, surgical procedure type, and previous hip fractures. CONCLUSIONS: In the study population, serum 25(OH)D(3) was an independent predictor of functional recovery assessed by Barthel Index score after hip fracture but not of the change in the functional score resulting from rehabilitation.

Functional recovery and length of stay after hip fracture in patients taking corticosteroids.

OBJECTIVE: To evaluate the functional recovery and the length of stay after hip fracture in patients receiving corticosteroids. DESIGN: A total of 796 inpatients with hip fracture consecutively admitted to our rehabilitation hospital were included in this retrospective study. A total of 36 of 796 were currently treated with either oral (n = 23) or inhaled (n = 13) corticosteroids. RESULTS: No significant differences were shown between corticosteroid users and controls for Barthel index score at admission or discharge, change in Barthel index score resulting from rehabilitation, and length of stay. Multiple regression, including 11 confounding variables, showed that several factors, but not the treatment with corticosteroids, were significantly associated with the Barthel index score or the length of stay. The results were similar when the two subgroups of patients receiving corticosteroids were evaluated separately. In the subgroup of the patients receiving oral corticosteroids, no meaningful correlations were observed between the daily dose (milligrams of prednisone equivalent) and the Barthel index score, the change in the Barthel index score attributable to rehabilitation, or the length of stay. CONCLUSIONS: After hip fracture, neither the functional recovery nor the length of stay were significantly affected by the current treatment with corticosteroids.

Functional recovery and length of stay after recurrent hip fracture.

OBJECTIVE: To evaluate the functional recovery and the rehabilitation length of stay after the sequential fracture of both hips in elderly patients. DESIGN: A total of 372 in-patients with hip fractures consecutively admitted to our rehabilitation hospital were included in this retrospective study. A total of 333 out of 372 were admitted for rehabilitation of their first hip fracture, and the other 39 patients had a second contralateral fracture. The functional recovery was evaluated by the Barthel index. The comparison between the two groups was performed by unpaired t test. Stepwise linear multiple regression analysis was performed, including nine prognostic factors together with the number of hip fractures (first or recurrent) as independent variables and the Barthel index score on discharge as the dependent variable. The statistical analysis was repeated, substituting hospital length of stay for Barthel index. RESULTS: Both the functional recovery and the length of stay of the patients affected by recurrent fracture were similar to the ones of the patients suffering from a single fracture. Regression analysis showed that the previous hip fracture was associated neither with the Barthel index nor with the length of stay. CONCLUSIONS: Our data suggest that the functional recovery in elderly patients with hip fractures is not significantly influenced by a previous fracture of the contralateral hip and that no significant prolonged rehabilitation length of stay is needed after the recurrent fracture.

Femur bone mineral density is independently associated with functional recovery after hip fracture in elderly women.

OBJECTIVE: To evaluate the association between femur bone mineral density (BMD) and functional recovery after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: A total of 233 of 263 white women with hip fracture consecutively admitted to a rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients underwent BMD assessment by dual-energy x-ray absorptiometry (DXA) at the proximal femur (5 sites) on admission. Functional recovery was evaluated by using Barthel Index scores. RESULTS: A positive correlation was found between BMD and Barthel Index scores assessed on both admission and discharge (r range,.16-.24, depending on the site of BMD measurement). Linear multiple regression showed that the association between BMD and Barthel Index score was independent of 10 confounding variables: age, body mass index, fracture type, pressure ulcers, cognitive impairment, neurologic diseases, total lymphocyte count as a nutritional index, time between fracture occurrence and DXA assessment, comorbidity, and surgical procedure. Conversely, no significant associations were found between BMD and the change in Barthel Index score attributable to rehabilitation. CONCLUSIONS: In the study population, femur BMD was an independent predictor of the functional recovery assessed by Barthel Index score after hip fracture, but not of the change in the functional score resulting from rehabilitation.

Functional recovery and length of stay after hip fracture in patients with neurologic impairment.

OBJECTIVE: To evaluate the functional recovery and the length of stay after hip fracture in patients with neurologic impairment. DESIGN: A total of 577 inpatients with hip fracture consecutively admitted to our rehabilitation hospital were included in this retrospective study. A total of 71 of 577 were affected by neurologic impairment caused by stroke with hemiplegia (n = 37), Parkinson's disease (n = 25), or other diseases (n = 9). RESULTS: Mean Barthel index was significantly lower in the patients with neurologic impairment than in the controls: 10.8 (95% confidence interval, 5.9-15.6; P < 0.001) at admission and 13.1 (95% confidence interval, 5.55-20.65; P < 0.001) at discharge. Multiple regression including eight confounding variables showed that neurologic impairment was negatively associated with the Barthel index. However, the mean increase in Barthel index through the course of rehabilitation was not affected by neurologic impairment. The length of stay was significantly higher in the patients with neurologic impairment, 3.84 days (95% confidence interval, 0.51-7.17; P < 0.05), and multiple regression showed that neurologic impairment was positively associated with the length of stay. CONCLUSIONS: After hip fracture, the presence of neurologic impairment was associated with lower Barthel index and longer length of stay, but it did not affect the increase in Barthel index due to a course of rehabilitation.