Clock drawing and rehabilitation outcome in hip fracture patients.

Abstract

To assess the relationship between the Clock Drawing Test (CDT) and rehabilitation outcome in hip fracture patients within normal range of the Mini Mental State Examination (MMSE). This retrospective study was performed in a post-acute geriatric rehabilitation centre. One hundred and forty-two patients with proximal hip fracture admitted from January 2006 to June 2008 whose MMSE scores was within normal range (>23) were enrolled in the study. The patients were divided into two groups according to CDT performance (impaired versus intact). The differences between the two groups in relation to age, gender, education level, living arrangement, pre fracture functional level, fracture type, and outcome measurements [Functional Independent Measure (FIM), motor FIM, Rate of in-hospital Improvement (RI) in FIM and motor FIM, and Length of Stay (LOS)] were assessed. Discharge FIM score and motor FIM scores were significantly lower for the impaired CDT group (89 ± 13.7 vs. 94.9 ± 11.6, p = 0.007; 61.6 ± 11.1 vs. 65.7 ± 9.6, p = 0.022 respectively); LOS was significantly longer (28.2 ± 7.9 vs. 25.3 ± 8.5, p = 0.033) and rates of improvement in FIM and motor FIM were significantly slower (0.62 ± 0.35 vs. 0.77 ± 0.45, p = 0.036; 0.61 ± 0.34 vs. 0.75 ± 0.42, p = 0.033, respectively). Nevertheless, FIM and motor FIM scores changes were similar in both CDT groups. Following adjustment for age, LOS of patients with impaired CDT was significantly longer (p = .027). The CDT may assist the multidisciplinary team in identifying hip fracture patients whose MMSE scores are within the normal range, but yet need a longer training period to extract their rehabilitation potential.