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Fay A, Synott E, McDaid E, Barrett E. A comparison of the immediate effects of the Andago over ground body weight support trainer versus over ground walking on selected gait parameters in a post-acute rehabilitation population. Physiother Theory Pract 2024; 40:767-777. [PMID: 36593733 DOI: 10.1080/09593985.2022.2162834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Andago is an electromechanical gait trainer providing dynamic body weight support while simultaneously enabling over ground walking. The aim of this study was to compare the effects of the Andago with over ground walking on selected gait parameters, during a single gait reeducation session in a post-acute rehabilitation population. METHODS Twenty-seven participants (mean age 78 yrs. (SD = 9.2), female 55.6% (n = 15)) undergoing rehabilitation for neurological (51.8%, n = 14), orthopedic (33.3%, n = 9), and medical conditions (14.8%, n = 4) completed the study. This was a single group, cross sectional, repeated measures study. Participants completed a 10-meter walk test (10MWT) and a 20-minute gait reeducation session under two conditions: i) harnessed in the Andago with body weight support or ii) using their normal walking pattern. Walking speed, steps taken, distance walked, rest breaks, Borg ratings of perceived exertion, and fear of falling were compared over both conditions. RESULTS Walking speed was significantly slower with the Andago (10MWT mean difference 0.12 (95% CI 0.03-0.20), eta squared 0.24, p = .008; 20-min gait mean difference 0.04 (95% CI 0.00-0.09), eta squared 0.15, p = .049). During the 20-minute gait reeducation session, step count, distance walked, and duration of walking was similar over both conditions, however participants recorded less rest breaks and fear of falling at minutes 10 and 20 in favor of the Andago. CONCLUSION Gait parameters measured during a single gait reeducation session in the Andago, in a mixed cohort of predominately older rehabilitation patients, appear comparable to conventional over ground training, other than walking speed which was reduced.
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Affiliation(s)
- Amy Fay
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, Ireland
| | - Eoin Synott
- Physiotherapy Department, Royal Hospital Donnybrook, Morehampton Road, Dublin, Ireland
| | - Edel McDaid
- Physiotherapy Department, Royal Hospital Donnybrook, Morehampton Road, Dublin, Ireland
| | - Emer Barrett
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, Ireland
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Kokotovic D, Schucany A, Soylu L, Fenger AQ, Puggard I, Ekeloef S, Gögenur I, Burcharth J. Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02408-4. [PMID: 38177561 DOI: 10.1007/s00068-023-02408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Major emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation. PURPOSE To investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications. METHODS The study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test. RESULTS The study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien-Dindo (CD) grade ≥ 3. CONCLUSIONS In patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.
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Affiliation(s)
- Dunja Kokotovic
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
- Emergency Surgery Research Group (EMERGE) Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Aide Schucany
- Department of Gastrointestinal Surgery, North Zealand University Hospital, Hillerød, Denmark
| | - Liv Soylu
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Andreas Q Fenger
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Iben Puggard
- Department of Physiotherapy, Zealand University Hospital, Køge, Denmark
| | - Sarah Ekeloef
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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Ko Y, Hwang JM, Baek SH. Discharge transitional care programme for older adults after hip fracture surgery: a quasi-experimental study. J Res Nurs 2023; 28:582-593. [PMID: 38162723 PMCID: PMC10756176 DOI: 10.1177/17449871231204499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Hip fractures require extended periods of recovery and rehabilitation, subjecting older adults to discontinuous care. Discharge transition is a critical point of heightened vulnerability for older adults. Aims This study aimed to evaluate the effectiveness of a transitional care programme on the physical functions and quality of life (QOL) of older adults after hip fracture surgery. Methods Seventy-five older adults were assessed from pre-discharge to 6 weeks after hip surgery, and their physical functions, including walking status and activities of daily living, were measured. The QOL was measured using the European Quality of life-5 Dimensions-5 Levels (EQ 5D 5L). Results There was a significant strong effect of time (B = 10.565; 95% CI = 2.584-18.547; p = 0.009) on the EuroQol Visual Analog Scale (EQ-VAS) for the experimental group. However, there were no significant effects of time on physical functions and EQ-5D-5L scores. Conclusions The discharge transitional care programme improved the EQ-VAS of older adults following hip fracture surgery 6 weeks post-surgery. However, there were no significant differences in physical functions and EQ-5D between the groups.
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Affiliation(s)
- YoungJi Ko
- Associate Professor, Department of Nursing, Daegu Haany University, South Korea
| | - Jong-Moon Hwang
- Assistant Professor, Department of Rehabilitation Medicine, Kyungpook National University Hospital, South Korea
| | - Seung-Hoon Baek
- Associate Professor, Department of Orthopedic Surgery, Kyungpook National University Hospital, South Korea
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van Dartel D, Wang Y, Hegeman JH, Vollenbroek-Hutten MMR. Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study. JMIR Rehabil Assist Technol 2023; 10:e45307. [PMID: 38032703 PMCID: PMC10727481 DOI: 10.2196/45307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/25/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions. OBJECTIVE This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home. METHODS The physical activity of patients aged ≥70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F1-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F1-score for all physical activity patterns together. RESULTS The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F1-score=1) and a 100% correct classification of the 2 most common physical activity patterns. CONCLUSIONS Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves.
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Affiliation(s)
- Dieuwke van Dartel
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Ying Wang
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Ziekenhuisgroep Twente Academy, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Johannes H Hegeman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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Niemöller U, Arnold A, Stein T, Juenemann M, Erkapic D, Rosenbauer J, Kostev K, Meyer M, Tanislav C. Comprehensive Geriatric Care in Older Adults: Walking Ability after an Acute Fracture. Med Sci (Basel) 2023; 11:40. [PMID: 37367739 DOI: 10.3390/medsci11020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES Comprehensive Geriatric Care (CGC) is a specific multimodal treatment for older patients. In the current study, we aimed to investigate walking performance after CGC in medically ill patients versus those with fractures. METHODS The timed up and go test (TuG), a 5-grade scale assessment (1 = no walking impairment to 5 = no walking ability at all) for evaluating individual walking ability was performed in all patients who underwent CGC prior to and after treatment. Factors associated with improvement in walking ability were analyzed in the subgroup of patients with fractures. RESULTS Out of 1263 hospitalized patients, 1099 underwent CGC (median age: 83.1 years (IQR 79.0-87.8 years); 64.1% were female). Patients with fractures (n = 300) were older than those without (n = 799), (median 85.6 versus 82.4 years, p = 0.001). Improvement in TuG after CGC was found in 54.2% of the fracture patients compared to just 45.9% of those without fractures. In fracture group patients, TuG improved from median 5 on admission to median 3 on discharge (p = 0.001). In fracture patients, improvement in walking ability was associated with higher Barthel index values on admission (median 45 (IQR: 35-55) versus 35 (IQR: 20-50): p = 0.001) and Tinetti assessment scores (median 9 (IQR: 4-14.25) versus 5 (IQR: 0-13); p = 0.001) and was negatively associated with the diagnosis of dementia (21.4% versus 31.5%; p = 0.058). CONCLUSION CGC improved walking ability in more than half of all patients examined. Older patients in particular might benefit from undergoing the procedure after an acute fracture. A better initial functional status favors a positive result following the treatment.
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Affiliation(s)
- Ulrich Niemöller
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Andreas Arnold
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Thomas Stein
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Martin Juenemann
- Department of Neurology, Justus Liebig University, 35392 Giessen, Germany
| | - Damir Erkapic
- Department of Cardiology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Josef Rosenbauer
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Karel Kostev
- Department of Epidemiology, Philipps University Marburg, 35043 Marburg, Germany
| | - Marco Meyer
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
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Kuo WY, Chen MC, Shyu YIL. Predictors of Abnormal Sleep Duration in Older Adults With Hip Fracture and Diabetes. J Nurs Res 2023; 31:e269. [PMID: 36976540 DOI: 10.1097/jnr.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Abnormal sleep duration affects recovery in older adults with hip fracture and diabetes mellitus (DM) negatively. However, the predictors of abnormal sleep duration in this population remain unknown. PURPOSE This study was designed to explore the predictors of abnormal sleep duration among older adults with hip fracture and DM within 6 months of hospital discharge. METHODS A longitudinal study using secondary data from a randomized controlled trial was implemented. Data on fracture-related factors (diagnosis, surgical methods) were collected from medical charts. Information on the duration of DM, methods of DM control, and diabetes-related peripheral vascular disease was collected by asking simple questions. Diabetic peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument. Sleep duration outcomes were determined using data collected from a SenseWear armband. RESULTS Having more comorbidities (OR = 3.14, p = .04), having undergone open reduction (OR = 2.65, p = .005), having undergone closed reduction with internal fixation (OR = 1.39, p = .04), and having DM (OR = 1.18, p = .01), diabetic peripheral neuropathy (OR = 9.60, p = .02), or diabetic peripheral vascular disease for a longer duration (OR = 15.62, p = .006) were all associated with a higher risk of abnormal sleep duration. CONCLUSIONS The findings indicate that patients with more comorbidities or who had undergone internal fixation, had a long DM history, or had complications are more likely to have abnormal sleep duration. Thus, greater attention should be focused on the sleep duration of diabetic older adults with hip fracture who are affected by these factors to achieve better postoperative recovery.
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Affiliation(s)
- Wen-Yu Kuo
- PhD, RN, Assistant Professor, School of Nursing, and Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan City, Taiwan, ROC
| | - Min-Chi Chen
- PhD, Professor, Department of Public Health & Biostatistics, Consulting Center, College of Medicine, Chang Gung University, and Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Yea-Ing Lotus Shyu
- PhD, RN, FAAN, Distinguished Professor, School of Nursing, College of Medicine, and Healthy Aging Research Center, Chang Gung University; Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology; and Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
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Huang MZ, Rogers MW, Pizac D, Gruber-Baldini AL, Orwig D, Hochberg MC, Beamer BA, Creath RA, Savin DN, Conroy VM, Mangione KK, Craik R, Zhang LQ, Magaziner J. Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial. Arch Phys Med Rehabil 2023; 104:169-178. [PMID: 36087806 PMCID: PMC10039715 DOI: 10.1016/j.apmr.2022.08.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of 16-week home-based physical therapy interventions on gait and muscle strength. DESIGN A single-blinded randomized controlled trial. SETTING General community. PARTICIPANTS Thirty-four older adults (N=34) post hip fracture were randomly assigned to either experimental group (a specific multi-component intervention group [PUSH], n=17, 10 women, age=78.6±7.3 years, 112.1±39.8 days post-fracture) or active control (a non-specific multi-component intervention group [PULSE], n=17, 11 women, age=77.8±7.8 years, 118.2±37.5 days post-fracture). INTERVENTION PUSH and PULSE groups received 32-40 sessions of specific or non-specific multi-component home-based physical therapy, respectively. Training in the PUSH group focused on lower extremity strength, endurance, balance, and function for community ambulation, while the PULSE group received active movement and transcutaneous electrical nerve stimulation on extremities. MAIN OUTCOME MEASURES Gait characteristics, and ankle and knee muscle strength were measured at baseline and 16 weeks. Cognitive testing of Trail Making Test (Part A: TMT-A; Part-B: TMT-B) was measured at baseline. RESULTS At 16 weeks, both groups demonstrated significant increases in usual (P<.05) and fast (P<.05) walking speed, while there was no significant difference in increases between the groups. There was only 1 significant change in lower limb muscle strength over time (non-fractured side) between the groups, such that PUSH did better (mean: 4.33%, 95% confidence interval:1.43%-7.23%). The increase in usual and fast walking speed correlated with the baseline Trail-making Test-B score (r=-0.371, P=.037) and improved muscle strength in the fractured limb (r=0.446, P=.001), respectively. CONCLUSION Gait speed improved in both home-based multicomponent physical therapy programs in older adults after hip fracture surgery. Muscle strength of the non-fractured limb improved in the group receiving specific physical therapy training. Specific interventions targeting modifiable factors such as muscle strength and cognitive performance may assist gait recovery after hip fracture surgery.
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Affiliation(s)
- Mei Zhen Huang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Douglas Pizac
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD
| | - Marc C Hochberg
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD
| | - Brock A Beamer
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD; Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Exercise Science, Lebanon Valley College, Annville, PA
| | - Douglas N Savin
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD
| | - Vincent M Conroy
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen K Mangione
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA
| | - Rebecca Craik
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, PA
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine, Baltimore, MD; Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD; Department of Bioengineering, University of Maryland, College Park, MD
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD.
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Hammer A, Ljungberg K, Bohman T, Andersson ÅG. Description and comparison of postoperative functioning of patients with hip fracture 2018 and 2008 at the Örebro University Hospital - a comparative cross-sectional study. BMC Geriatr 2022; 22:842. [DOI: 10.1186/s12877-022-03553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hip fractures are a global problem, and it will probably increase. Hip fractures impair health aspects which creates demands on postoperative care. This study describes and compares patients with hip fracture in 2008 and in 2018. An increased knowledge of this group could be a basis how to optimize aftercare and dimension rehabilitation.
Methods
Using a comparative cross-sectional study to describe and compare patients with hip fracture from 2018 and 2008 at Örebro University Hospital regarding age, sex, multimorbidity, fracture type, surgical materials, surgery within 24 hours, length of stay, postoperative walking ability, physical activity level and hand grip strength. Data was collected from 76 patients with hip fracture from 2018 and 78 patients from 2008. Outcome measures considering functioning were walking ability (Functional Ambulation Categories), physical activity level (Classification system of physical activity) and hand grip strength (Jamar hand dynamometer). Statistical analyses used were hypothesis tests and regressions analysis.
Results
No differences in age, sex, fracture type, proportion of surgery within 24 hours or length of stay between the cohorts. The cohort 2018 had more multimorbidity in number of diagnoses and ASA-classification preoperatively. In 2018 70% of the participants were dependent in walking ability (physical human support) compared to 43% 2008 (p = 0.007). Proportion of physically inactive was 9% in 2018 compared to 21% 2008 (p = 0.047). Hand grip strength was 5.1 kg better in 2018 (p = 0.011). Adjusted for age, sex, ASA-classification (American Society of Anaesthesiologists Classification System), surgical materials and number of days between surgery and testing the cohort of 2018 had a lower odds to have independent walking ability and higher odds to be physical active. Differences in hand grip strength decreased to 4.7 kg. Participants in 2018 suffered significantly more multimorbidity.
Conclusions
Study indicated differences in patients’ postoperative functioning between 2018 and 2008 with more impaired walking ability, more multimorbidity, higher proportion of physically active and better hand grip strength 2018. The results are important for future reasoning regarding care needs of patients with hip fracture.
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Vaajala M, Kuitunen I, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM. The rate of elective cesarean section after pelvic or hip fracture remains high even after the long-term follow-up: A nationwide register-based study in Finland. Eur J Obstet Gynecol Reprod Biol 2022; 277:77-83. [PMID: 36037663 DOI: 10.1016/j.ejogrb.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are only few studies on the effects of pelvic or hip fractures on subsequent delivery outcomes. The aim for this study is to evaluate in a nationwide sample whether the rate of elective CS and emergency CS would decrease during the time after maternal hip and pelvic fracture. MATERIAL AND METHODS In this nationwide registry-based study, data on all women aged 15-49 years with pelvic or hip fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 1998-2018. Wrist fractures were used as a control group. The data were linked with data from the National Birth Register, where each first pregnancy during the 14-year follow-up is collected. The delivery outcomes of these pregnancies were analyzed. The results were interpreted with odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (CI). RESULTS A total of 2878 women with pelvic fracture, 1330 women with hip fracture, and 29 580 with wrist fracture found in the Care Register for Health Care. Of these, a total of 586 (20.4 %) women gave birth during the following 14 years after pelvic fracture, 147 (11.0 %) women after hip fracture, and 5255 (17.7 %) women after wrist fracture. Women with pelvic fracture had higher odds for CS during each time period. The aOR for CS was 1.62 (CI 1.22-2.12) during first 5 years, 1.87 (CI 1.33-2.62) during years 5-10, and 1.97 (CI 1.11-3.41) during years 10-14. Women with hip fractures had notably higher odds for CS during first 5 years after fracture (aOR 1.64, CI 1.40-2.67). CONCLUSIONS The results of this study advocate that vaginal delivery is generally possible rather quickly after hip or pelvic fracture. Unplanned CS after hip fractures was more common at the beginning, but the exact reason for this remains unknown and further research should be made on this topic.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland; Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
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Effect of denosumab on renal function in women with osteoporosis evaluated using cystatin C. Osteoporos Sarcopenia 2022; 8:68-74. [PMID: 35832419 PMCID: PMC9263171 DOI: 10.1016/j.afos.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives To investigate renal function during denosumab therapy using the estimated glomerular filtration rate based on cystatin C (eGFRcys) which is more accurate than creatinine (eGFRcr) for renal function. Methods Bone mineral densities (BMDs) of lumbar spine and hip regions, eGFRcys, eGFRcr, creatinine clearance (Ccr), and serum total homocysteine (S-Hcy) were measured during 2-year denosumab therapy in 53 women with osteoporosis naïve to anti-osteoporosis drugs (new group) and 64 women who were switched from long-term bisphosphonate treatment to denosumab therapy (switch group). Results There were no significant differences in age, eGFRcr, Ccr, eGFRcys, and S-Hcy levels at baseline between the groups. BMDs in the lumbar spine, femoral neck, and total hip increased significantly after 2-year denosumab therapy in both groups. eGFRcr decreased in the switch group, and Ccr decreased in both groups; however, eGFRcys and S-Hcy levels did not change significantly in either group. To investigate the causal factors associated with the decrease in eGFRcr and Ccr, multiple regression analysis was performed in all patients. Denosumab initiation within 3 months after fracture and eGFRcr or Ccr at baseline were independent factors for the decrease in eGFRcr or Ccr during the 2-year denosumab therapy. Decline in creatinine-based renal function could be reflected by increased muscle mass during the ongoing recovery from fracture. Conclusions Renal function was preserved in all patients, including those in the switch group during denosumab therapy. Creatinine-based renal function should be cautiously interpreted during denosumab therapy in patients with recent fractures.
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Jang SY, Lee JW, Kim KJ, Kim HY, Choy WS, Cha Y. Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study. Clin Orthop Relat Res 2022; 480:891-902. [PMID: 34807010 PMCID: PMC9007206 DOI: 10.1097/corr.0000000000002051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies on medical costs in patients with hip fractures have focused on medical costs incurred for a short period after the injury. However, patients often had comorbidities before their hip fractures that would have affected medical costs even had they not sustained a fracture. Consequently, these studies may have overestimated the costs associated with hip fractures and did not characterize the duration of increased medical costs adequately. Without knowing this crucial information, it is difficult to craft thoughtful health policy to support these patients' needs. QUESTIONS/PURPOSES (1) To compare the direct medical costs for 5 years before fracture and up to 5 years after injury in a group of patients who underwent hip fracture surgery with a matched group of patients who did not experience a hip fracture, (2) to analyze the duration over which the increased direct medical costs associated with a hip fracture continues, and (3) to analyze whether there is a difference in direct medical costs according to age group using a nationwide claims database in South Korea. METHODS The National Health Insurance Service Sample cohort in South Korea consisted of 1 million patients who were selected using a systematic, stratified, random sampling method from 48,222,537 individuals on December 31, 2006. Under a compulsory social insurance system established by the National Health Insurance Act, all patients were followed until 2015. Patients with hip fractures and matched controls were selected from the National Health Insurance Service sample of South Korea. Patients with hip fractures were defined as those who were hospitalized with a diagnosis of femoral neck fracture or intertrochanteric fracture and who underwent surgical treatment. We excluded patients with hip fractures before January 1, 2007 to ensure a minimum 5-year period that was free of hip fractures. Patients with hip fractures were matched with patients of the same age and gender at the date of admission to an acute care hospital for surgery (time zero). If patients with hip fractures died during the follow-up period, we performed matching among patients whose difference from the time of death was within 1 month. This method of risk-set matching was repeated sequentially for the next patient until the last patient with a hip fracture was matched. We then sequentially performed 1:5 random sampling for each risk set. A total of 3583 patients in the hip fracture cohort (patients with hip fractures) and 17,915 patients in the matched cohort (those without hip fractures) were included in this study. The mean age was 76 ± 9 years, and 70% were women in both groups. Based on the Charlson comorbidity index score, medication, and medical history, the patients with hip fractures had more comorbidities. Person-level direct medical costs per quarter were calculated for 5 years before time zero and up to 5 years after time zero. Direct medical costs were defined as the sum of that insurer's payments (that is, the National Health Insurance Service's payments), and that patient's copayments, excluding uncovered payments. We compared direct medical costs between patients with hip fractures and the patients in the matched cohort using a comparative interrupted time series analysis. The difference-in-difference estimate is the ratio of the differences in direct medical costs before and after time zero in the hip fracture cohort to the difference in direct medical costs before and after time zero in the matched cohort; the difference in difference estimates were calculated each year after injury. To identify changes in direct medical cost trends in patients with hip fractures and all subgroups, joinpoint regression was estimated using statistical software. RESULTS The direct medical costs for the patients with hip fractures were higher than those for patients in the matched cohort at every year during the observation period. The difference in direct medical costs between the groups before time zero has increased every year. The direct medical costs in patients with hip fractures was the highest in the first quarter after time zero. Considering the differential changes in direct medical costs before and after time zero, hip fractures incurred additional direct medical costs of USD 2514 (95% CI 2423 to 2606; p < 0.01) per patient and USD 264 (95% CI 166 to 361; p < 0.01) per patient in the first and second years, respectively. The increase in direct medical costs attributable to hip fracture was observed for 1.5 to 2 years (difference-in-difference estimate at 1 year 3.0 [95% CI 2.8 to 3.2]; p < 0.01) (difference-in-difference estimate at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 year). In the subgroups of patients younger than 65, patients between 65 and 85, and patients older than 85 years of age, the increase in direct medical costs attributable to hip fracture continued up to 1 year (difference-in-difference estimate ratio at 1 year 2.7 [95% CI 2.1 to 3.4]; p < 0.01; joinpoint 1 year), 1.5 to 2 years (difference-in-difference estimate ratio at 1 year 2.8 [95% CI 2.6 to 3.1]; p < 0.01; difference-in-difference estimate ratio at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 years), and 39 months to 5 years (difference-in-difference estimate ratio at 1 year 5.2 [95% CI 4.4 to 6.2]; p < 0.01; difference-in-difference estimate ratio at 5 years 2.1 [95% CI 1.4 to 3.1]; p < 0.01; joinpoint 39 months) from time zero, respectively. CONCLUSION The direct medical costs in patients with hip fractures were higher than those in the matched cohort every year during the 5 years before and after hip fracture. The increase in direct medical costs because of hip fractures was maintained for 1.5 to 2 years and was greater in older patients. Based on this, we suggest that health policies should focus on patients' financial and social needs, with particular emphasis on the first 2 years after hip fracture with stratification based on patients' ages. LEVEL OF EVIDENCE Level II, economic analysis.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jang-Won Lee
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Zhang H, Sun F, Li Y. Application of Smart Healthcare in Comparative Analysis of Effect of Early External Fixator and Plate Internal Fixation Treatment on Postoperative Complications and Lower Limb Function Recovery of Patients With Unstable Pelvic Fracture. Front Public Health 2022; 10:887123. [PMID: 35570973 PMCID: PMC9099004 DOI: 10.3389/fpubh.2022.887123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo comparatively analyze the effect of early external fixator and plate internal fixation treatment on postoperative complications and lower limb function recovery of patients with unstable pelvic fracture based on smart healthcare.MethodsThe clinical data of 98 patients with unstable pelvic fractures treated in our hospital from August 2018 to August 2021 were collected for retrospective analysis, and the patients were split into group A (plate internal fixation, n = 49) and group B (early external fixator treatment, n = 49) according to the surgical modalities. The time of operation, intraoperative blood loss, postoperative complications, etc. were compared between the two groups.ResultsBetween the two groups, group B had significantly better clinical indicators (P < 0.001), a greatly higher good rate of fracture reduction and postoperative Harris score (P < 0.05), and obviously lower VAS score and total incidence rate of postoperative complications (P < 0.05).ConclusionThrough the analysis based on smart healthcare, it is found that compared with plate internal fixation treatment, early external fixator treatment presents a better effect in treating patients with unstable pelvic fracture, because it is a reliable method to accelerate fracture healing, reduce postoperative complications, and improve lower limb function.
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Affiliation(s)
- Hongwei Zhang
- Department of Emergency, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Fang Sun
- Plastic Burn Beauty Center, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Yao Li
- Department of Orthopeadic Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
- *Correspondence: Yao Li
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13
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What is the subtype of dementia in patients with fragility hip fracture? PLoS One 2022; 17:e0265636. [PMID: 35381010 PMCID: PMC8982891 DOI: 10.1371/journal.pone.0265636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Cognitive function is an important factor that affects functional recovery after hip fracture (HipFx) surgery. The literature on the pathophysiology of dementia in HipFx patients is scarce. We performed a differential diagnosis of dementia in HipFx patients using clinical and brain MRI findings.
Methods
This is a prospective study in which brain MRI was evaluated for patients with HipFx for research purposes. One-hundred-and-five HipFx patients (85 females and 20 males) who underwent surgery and were subsequently able to undergo brain MRI at our hospital were evaluated. The mean age was 84 years. The presence of dementia was determined based on clinical findings and whether the patient meets its diagnostic criteria according to the International Classification of Diseases 10th Edition (ICD-10). The differential diagnosis of dementia was made based on brain MRI findings and the dementia diagnostic flow chart published in the Clinical Practice Guideline for Dementia 2017 (Japanese Society of Neurology). The Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD) advance 2 diagnostic software was used to evaluate atrophy of the para-hippocampal gyrus.
Results
Fifty-six (53%) patients were clinically diagnosed with dementia according to the ICD-10 criteria. The MRI findings were diverse: Alzheimer’s disease (AD)-type, asymptomatic multiple ischemic cerebral lesions, past symptomatic cerebral infarction or cerebral hemorrhage, Binswanger’s disease (BW)-type, chronic subdural hematoma, disproportionately enlarged subarachnoidal hydrocephalus (DESH), and their combinations thereof. A combination of MRI and clinical findings of dementia patients demonstrated the following distribution of dementia subtypes: AD (n = 20), vascular dementia (n = 33), AD and BW vascular dementia (n = 3).
Conclusion
This study revealed that the brain MRI findings of HipFx patients were diverse. Although vascular dementia is found to be common in this particular population, this could be an incidental finding. Further study is warranted to clarify the specificity of our findings by increasing the number of patients, setting the control, and investigating whether dementia subtypes affect postoperative gait acquisition and fall risk.
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14
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Connelly DM. Recovery in Mobility by Community-Living Older Adults following Fragility Hip Fracture. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2021.2008086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise M. Connelly
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario London Ontario, Canada
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15
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Aguado HJ, Castillón-Bernal P, Ventura-Wichner PS, Cervera-Díaz MC, Abarca-Vegas J, García-Flórez L, Salvador-Carreño J, García-Virto V, Simón-Pérez C, Ojeda-Thies C, Sáez-López P, González-Montalvo JI. Impact of subtrochanteric fractures in the geriatric population: better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry. J Orthop Traumatol 2022; 23:17. [PMID: 35347459 PMCID: PMC8960105 DOI: 10.1186/s10195-022-00637-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures. Hypothesis Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures. Materials and methods Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included. Results A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population. Conclusions Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly. Level of evidence: IV. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-022-00637-8.
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Affiliation(s)
- Héctor J Aguado
- Orthogeriatric Unit, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario, Av. Ramón y Cajal 3, 47003, Valladolid, Spain. .,Universidad de Valladolid (UVA), Valladolid, Spain.
| | - Pablo Castillón-Bernal
- Trauma Department, Hospital Universitari Mútua de Terrassa Plaza Dr, Robert 5, 08221, Terrasa, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Paula S Ventura-Wichner
- Fundación de Investigación HM Hospitales & Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - María C Cervera-Díaz
- Orthogeriatric Unit, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario, Av. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Javier Abarca-Vegas
- Trauma Department, Hospital Universitari Mútua de Terrassa Plaza Dr, Robert 5, 08221, Terrasa, Barcelona, Spain
| | - Luis García-Flórez
- Orthogeriatric Unit, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario, Av. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Jordi Salvador-Carreño
- Trauma Department, Hospital Universitari Mútua de Terrassa Plaza Dr, Robert 5, 08221, Terrasa, Barcelona, Spain
| | - Virginia García-Virto
- Orthogeriatric Unit, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario, Av. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Clarisa Simón-Pérez
- Orthogeriatric Unit, Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínico Universitario, Av. Ramón y Cajal 3, 47003, Valladolid, Spain.,Universidad de Valladolid (UVA), Valladolid, Spain
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pilar Sáez-López
- Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain.,Department of Geriatrics, Hospital Universitario Fundación Alcorcón, Madrid, Spain.,Head Coordinator of the Spanish National Hip Fracture Registry, Madrid, Spain
| | - Juan I González-Montalvo
- Instituto de Investigación del Hospital La Paz, IdiPAZ, Madrid, Spain.,Geriatric Medicine Department, Hospital Universitario La Paz, Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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16
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Li N, van Oostwaard M, van den Bergh JP, Hiligsmann M, Boonen A, van Kuijk SMJ, Vranken L, Bours SPG, Wyers CE. Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study. Osteoporos Int 2022; 33:577-588. [PMID: 34671823 PMCID: PMC8843901 DOI: 10.1007/s00198-021-06204-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline. INTRODUCTION To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV). METHODS Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV. RESULTS A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: - 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations. CONCLUSION The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV.
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Affiliation(s)
- N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M van Oostwaard
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Vranken
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
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17
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Sim DS, Tay K, Howe TS, Koh SBJ. Preoperative severe vitamin D deficiency is a significant independent risk factor for poorer functional outcome and quality of life 6 months after surgery for fragility hip fractures. Osteoporos Int 2021; 32:2217-2224. [PMID: 33959793 DOI: 10.1007/s00198-021-05970-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED Hip fractures are common in the elderly, and many patients with hip fractures have low vitamin D levels. This study found that severe vitamin D deficiency is linked to poorer recovery of function and quality of life after hip fracture surgery. INTRODUCTION Vitamin D deficiency is prevalent in hip fracture patients and associated with increased mortality and complications. However, there is limited long-term data on how vitamin D levels affect functional outcomes after hip fracture surgery. The aim of this study is to ascertain the association between vitamin D levels and recovery from hip surgery. METHODS Patients who underwent hip fracture surgery from January 2012 to December 2016 and had vitamin D levels assessed during admission were included. Retrospective analysis was performed on patients' demographic data such as age, gender and clinical parameters such as preoperative vitamin D, haemoglobin levels, Charlson Comorbidity Index (CCI), and type and site of surgery. Patients were divided according to four different vitamin D levels-severe vitamin D deficiency (≤10 ng/mL), mild deficiency (10-20 ng/ml), insufficiency (20-30 ng/ml), and normal (>30ng/ml). Functional outcomes were measured by Harris Hip Score (HHS), Parker Mobility Score (PMS), and individual domains of 36-Item Short Form Health Survey (SF36). Univariate and multivariate analyses were conducted to examine the association between vitamin D deficiency and functional outcome scores. RESULTS Out of 664 patients identified, 9% had severe vitamin D deficiency and 39% mild deficiency. Patients with severe vitamin D deficiency had significantly poorer baseline and 6-month PMS and SF36 Physical Functioning (PF). In multivariate analysis, severe vitamin D deficiency was associated with lower 6-month PMS and SF36 PF. CONCLUSION Preoperative severe vitamin D deficiency is an independent risk factor for poorer recovery of function and quality of life after hip fracture surgery.
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Affiliation(s)
- D S Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - K Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - T S Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - S B J Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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18
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Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2. Crit Care Clin 2021; 37:221-231. [PMID: 33190772 DOI: 10.1016/j.ccc.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.
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19
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Fu G, Li H, Wang H, Zhang R, Li M, Liao J, Ma Y, Zheng Q, Li Q. Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients - A Retrospective, Propensity-Score Matched Study. Clin Interv Aging 2021; 16:833-841. [PMID: 34040360 PMCID: PMC8139682 DOI: 10.2147/cia.s311188] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To compare the effects of peripheral nerve block (PNB) and spinal anesthesia (SA) on one-year mortality and walking ability of elderly hip fracture patients after hip arthroplasty. Methods Patients ≥65 years who underwent unilateral hip arthroplasty due to femoral neck fracture, using either PNB or SA from 2014 to 2019, were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for PNB and SA groups. The primary outcomes were 30-day, 90-day, and one-year mortality. Secondary outcomes included walking ability in the first postoperative year, major complications, length of stay, and the cost of hospitalization. Survival analysis was performed using Kaplan-Meier method. Results Three hundred and sixteen patients were included, of whom 200 received SA and 116 received PNB. Eighty-nine patients in each group were matched after PSM. Patients in the PNB group showed significantly lower risks of death in 30 days (2.2% vs 10.1%, P=0.029) and 90 days (3.4% vs 12.4%, P=0.026) after hip arthroplasty, when compared to the SA group. There was no significant difference in one-year mortality, walking ability, major complications, and length of stay. Higher hospitalization cost was found in the PNB group (53,828.21 CNY vs 59,278.83 CNY, P=0.024). One-year accumulated survival rate was higher in the PNB group without reaching a significant level. Conclusion PNB was related to lower 30- and 90-day mortality but higher hospitalization cost in elderly hip fracture patients after hip arthroplasty. However, the anesthesia types were not associated with one-year mortality, one-year walking ability, major complications, and length of stay.
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Affiliation(s)
- Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Haotao Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China.,College of Clinical Medicine, Shantou University, Shantou, Guangdong Province, People's Republic of China
| | - Hao Wang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Ruiying Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Junxing Liao
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Qingtian Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
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20
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Improved Balance and Gait Ability and Basic Activities of Daily Living after Comprehensive Geriatric Care in Frail Older Patients with Fractures. HEALTHCARE (BASEL, SWITZERLAND) 2021; 9:healthcare9050560. [PMID: 34064552 PMCID: PMC8151142 DOI: 10.3390/healthcare9050560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/03/2022]
Abstract
(1) Purpose: Comprehensive geriatric care (CGC) is a multidisciplinary treatment approach for elderly patients. We aimed to investigate outcomes in fracture patients who had been treated using this approach in a large geriatric unit. (2) Methods: This observational cohort study assessed the gait function (using the Tinetti Balance and Gait Test (TBGT)) and basic activities of daily living (ADL) (using the Barthel index (BI)) before and after CGC and compared the results. Baseline data, walking ability assessments (Timed Up and Go, TUG), and cognitive status (mini mental status examination, MMSE) were also analyzed in the subgroup of patients with versus without fractures. (3) Results: Out of 1263 hospitalized patients, 1099 received CGC (median age: 83.1 years (IQR: 79.0–87.8 years); 64.1% were female). TBGT improvement was observed in 90.7% and BI increased in 82.7% of fracture patients. A TBGT improvement of >5 was noted in 47.3% and was associated with female sex, a lower BI at admission (median: 40 versus 45; p = 0.010), and poorer mobility on admission (TUG: median 5 versus 4; p = 0.001). An improvement in BI of ≥15 was observed in 63.0% of the cases, and was associated with a better cognitive status (MMSE: median 25 versus 18; p = 0.001) and inversely associated with diabetes mellitus and a previous stroke. (4) Conclusion: CGC in specialized geriatric units improves the balance and gait and the basic ADL in geriatric patients. After fracture, female patients are more likely to experience improvements in gait and balance, while patients with better cognitive condition are more likely to experience improvements in ADL.
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van Dartel D, Vermeer M, Folbert EC, Arends AJ, Vollenbroek-Hutten MMR, Hegeman JH. Early Predictors for Discharge to Geriatric Rehabilitation after Hip Fracture Treatment of Older Patients. J Am Med Dir Assoc 2021; 22:2454-2460. [PMID: 33933417 DOI: 10.1016/j.jamda.2021.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included. METHODS Patients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors. RESULTS Higher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively. CONCLUSIONS AND IMPLICATIONS This study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands.
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Ellis C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Arend J Arends
- Department of Geriatrics, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
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Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep 2020; 18:633-645. [PMID: 33030682 DOI: 10.1007/s11914-020-00623-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Low muscle strength and poor physical performance are associated with high risk of fracture. Many studies assessed clinical and functional outcomes of fractures. Fewer studies analyzed the impact of fractures on muscle strength and physical performance. RECENT FINDINGS Vertebral fractures (especially multiple and severe ones) are associated with back pain, back-related disability, lower grip strength, lower strength of lower limbs, lower gait speed, and poor balance. Patients with hip fracture have slower gait and lower quadriceps strength. Non-vertebral fractures were associated with lower strength of the muscles adjacent to the fracture site (e.g., grip strength in the case of distal radius fracture, knee extensors in the case of patellar fracture) and poor physical function dependent on the muscles adjacent to the fracture site (e.g., limited range of motion of the shoulder in the case of humerus fracture, gait disturbances in the case of the ankle fracture). Individuals with a fracture experience a substantial deterioration of muscle strength and physical performance which exceeds that related to aging and is focused on the period close to the fracture occurrence. After fracture, muscle strength increased and physical performance improved. The rate of normalization depended partly on the therapeutic approach and on the rehabilitation program. A subgroup of patients, mainly the elderly, never returns to the pre-fracture level of physical performance. The permanent decline of physical function after fracture may be related to the limitation of movements due to pain, low physical activity, poor health before the fracture, and reduced efficacy of retraining after immobilization.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
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Kristensen MT. Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1841. [PMID: 32363803 DOI: 10.1002/pri.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the influence and risk of falls of individual factors on timed up and go test (TUG) times using standardized instructions in patients with hip fracture upon discharge from an acute orthopaedic hip fracture unit. METHODS Following instructions, the TUG was performed three times with a rollator (standardized aid), as fast as safely possible. Up to a 1-min rest was given after the first and second TUG trial. Multivariable linear regression analysis was used to investigate the factors influencing TUG-times and corresponding logistic analysis was used to investigate factors indicating risk of falls, using a cut-off of 24 s for TUG. RESULTS A total of 181 patients (122 women), 60 years or older, with a mean (SD) age of 78.1 (9.1) years were studied. The fastest of three TUG trials performed within a mean of 10.0 (5.2) post-surgery days and used in analyses reached a mean of 25.6 (11.0) s. Multivariable regression analysis showed that greater age (B = 0.24; 2.4s more per decade older), a low pre-fracture function level (New Mobility Score <7 points, B = 6.4s more than high level), having a trochanteric fracture (B = 6.2 s, vs. cervical), and the post-surgery day of testing (B = 0.42, 4.2s per 10 days later) were independently associated with using more time for performing the TUG. Correspondingly, the same four factors indicated an increased risk of falls in the logistic analysis. The linear model explained 28% of the variance on TUG, while the accuracy of the logistic model to predict patients having TUG≥24 s was 69%. CONCLUSION The age, pre-fracture function, fracture type and post-surgery day of TUG testing were identified as strong factors influencing TUG performances and TUG-times indicating risk of falls in patients with hip fracture. We suggest that these factors be considered when interpreting TUG test results and in further rehabilitation and fall prevention efforts.
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Affiliation(s)
- Morten T Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Chinzei N, Noda M, Matsushita T, Inui A, Osawa S, Okimura K, Takahashi M, Saegusa Y. Does the duration to bipolar hip arthroplasty for femoral neck fracture influence on postoperative muscular strength? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:251-256. [PMID: 31493025 DOI: 10.1007/s00590-019-02545-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The primary purpose of this study was to compare the postoperative muscular strength and functional performance between early versus late bipolar hip arthroplasty (BHA) intervention for femoral neck fracture classified by the duration from the onset to surgery. METHODS Twenty-one patients who could walk at 12 months or more after BHA were enrolled into this study. We examined the muscular strength of hip flexion, extension, abduction, and knee extension of these patients. Time of one-leg standing, timed up and go test, pain grade by visual analog scale, and Barthel index were also evaluated as functional indices. We classified these patients into two groups by the duration from the onset to surgery, namely: within 3 days until BHA (early OP) and more than 4 days (late OP) to compare these indices at the latest follow-up. RESULTS The mean days until operation were 2.3 days in the early-OP group and 5.9 days in the late-OP group, showing a significant difference between the two groups. Muscular strength and other functional indices were also found to have no significant differences between these two groups. CONCLUSION Our study suggests that the delay to operate might not severely compromise the muscular strength around the hip joint for least 1.5 years among ambulatory patients.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Mitsuaki Noda
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Nishi Hospital, Kobe, 657-0037, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Shin Osawa
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Kenjiro Okimura
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Masayasu Takahashi
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
| | - Yasuhiro Saegusa
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, 658-0064, Japan
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