Determinants of functional outcome in hip fracture patients: The role of specific neuropsychiatric symptoms

Background: The correlation between single neuropsychiatric symptoms and functional outcome in hip fracture patients is little investigated in the literature, and it is not yet established which neuropsychiatric symptoms are the most important determinants of functional outcome. Aim: To determine which neuropsychiatric symptoms are the most important determinants of functional outcome. Methods: This prospective study was carried out in 204 consecutive patients with primary diagnosis of hip fracture admitted to our Rehabilitation Unit for a course of rehabilitation. Neuropsychiatric symptoms were assessed at admission with the Neuropsychiatric Inventory (NPI). Outcome measures of rehabilitation were: final score, efficiency and effectiveness in motor-Functional Independence Measure (motor-FIM), and discharge destination. Pearson's correlation coefficients were used to assess the relationship between NPI variables and the outcome measures, while backward stepwise regression was used to identify determinants of the outcome measures. Results: Pearson's correlation showed that night-time behavior disturbances were related to all outcome measures, while agitation, depression, elation, apathy, disinhibition and irritability were significantly related to motor-FIM outcomes. At multivariate regression analysis agitation was the only determinant of final motor-FIM score, while irritability was the only determinant of efficiency and effectiveness in motor-FIM score. No neuropsychiatric symptom was a determinant of discharge destination. Conclusions: This study highlights that in hip fracture patients there are relationships between specific neuropsychiatric symptoms and functional outcome. Among the neuropsychiatric symptoms, irritability and agitation are the most important. They are associated to poor functional outcome and are the only determinants of motor-FIM outcome measures.Implications for RehabilitationRelationships between specific neuropsychiatric symptoms and functional outcome have not been clearly described in hip fracture patients.Irritability and agitation have been shown to have the strongest relationship with poor functional outcomes.Appropriate identification, assessment and treatment of neuropsychiatric symptoms may be useful to physicians for the management of hip fracture patients.