Abstract
How can OTPs increase the likelihood of their patients returning home after a femur fracture? This presentation will provide insight into significant factors affecting discharge to home through the lens of the International Classification of Functioning, Disability and Health (ICF) model.
Primary Author and Speaker: Emily Colantonio
Additional Authors and Speakers: Jessica Dawn Tsotsoros
Contributing Authors: Hongwu Wang, Yuan Li
As the population of older adults grows and life expectancy increases, so does the prevalence of femur fractures (Walter et al., 2023). This study analyzed factors of the International Classification of Functioning, Disability, and Health (ICF) Model to inform treatment planning to promote discharge to home for patients with a femur fracture (World Health Organization, 2001) using a retrospective cohort study from a closed chart review. Participants included 343 adults with a femur fracture within a local inpatient rehabilitation facility (IRF) (M age=78.08 yr, SD=10.86). Univariate and multivariate regression analysis assessed factors characterized by the ICF Model effect on discharge to home. Independence in the activity domain of the ICF, primarily toileting (odds ratio [OR] 7.18; 95% Confidence Interval [CI] 3.78,13.79), toilet transfers (OR 8.68; 95% CI 3.42,17.64), and lower body dressing (OR 7.09; 95% CI 3.69,13.63), increased rates of a home discharge. For personal factors, independence with self-care tasks (OR 3.05; 95% CI 1.54,6.05) and ambulation (OR 2.95; 95% CI 1.42,6.17) before admission as well as intact cognitive functions (OR 3.52; 95% CI 1.94,6.40) increased the likelihood to discharge home. For body functions and structures, patients with a nail/screw-based surgery were more likely to discharge home. Within the environmental factors domain, home setup was not significant, but living alone decreased the likelihood to discharge home. This study promotes patient-centered care through use of all the domains of the ICF model to promote recovery. The activity domain was a significant predictor for discharge to home and one that occupational therapists (OTs) impact. Findings indicate OT practitioners should address toileting, toilet transfers, and dressing to promote a discharge to home. Additionally, there is a need for local hospitals to support older adults to pursue active lifestyles through community outreach and education.
Walter, N., Szymski, D., Kurtz, S. M., Lowenberg, D. W., Alt, V., Lau, E. C., & Rupp, M. (2023). Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-40087-8
World Health Organization. (2001). International classification of functioning, disability and health.