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Kraaijkamp JJM, Stijntjes M, De Groot JH, Chavannes NH, Achterberg WP, van Dam van Isselt EF. Movement Patterns in Older Adults Recovering From Hip Fracture. J Aging Phys Act 2024; 32:312-320. [PMID: 38215728 DOI: 10.1123/japa.2023-0090] [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: 03/27/2023] [Revised: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 01/14/2024]
Abstract
The aim of this study was to quantify physical activity and sedentary behavior in older adults recovering from hip fracture and to identify groups based on movement patterns. In this cross-sectional cohort study, older adults (≥70 years) were included 3 months after surgery for proximal femoral fracture. Patients received an accelerometer for 7 days. Demographics and outcomes related to physical function, mobility, cognitive functions, quality of life, and hip fracture were assessed. In total, 43 patients with sufficient accelerometer wear time were included. Across all groups, participants engaged in very low levels of physical activity, spending an average of 11 hr/day in prolonged sedentary behavior. Based on the extracted components from a principal component analysis, three groups with substantial differences in levels of physical activity and sedentary behavior could be distinguished.
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Affiliation(s)
- Jules J M Kraaijkamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- ZZG Zorggroep, Nijmegen, the Netherlands
| | - Marjon Stijntjes
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
- BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Jurriaan H De Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Phang JK, Lim ZY, Yee WQ, Tan CYF, Kwan YH, Low LL. Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials. BMC Musculoskelet Disord 2023; 24:417. [PMID: 37231406 DOI: 10.1186/s12891-023-06512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Interventions provided after hip fracture surgery have been shown to reduce mortality and improve functional outcomes. While some systematic studies have evaluated the efficacy of post-surgery interventions, there lacks a systematically rigorous examination of all the post-surgery interventions which allows healthcare providers to easily identify post-operative interventions most pertinent to patient's recovery. OBJECTIVES We aim to provide an overview of the available evidence on post-surgery interventions provided in the acute, subacute and community settings to improve outcomes for patients with hip fractures. METHODS We performed a systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). We included articles that were (1) randomized controlled trials (RCTs), (2) involved post-surgery interventions that were conducted in the acute, subacute or community settings and (3) conducted among older patients above 65 years old with any type of non-pathological hip fracture that was surgically treated, and who were able to walk without assistance prior to the fracture. We excluded (1) non-English language articles, (2) abstract-only publications, (3) articles with only surgical interventions, (4) articles with interventions that commenced pre-surgery or immediately upon completion of surgery or blood transfusion, (5) animal studies. Due to the large number of RCTs identified, we only included "good quality" RCTs with Jadad score ≥ 3 for data extraction and synthesis. RESULTS Our literature search has identified 109 good quality RCTs on post-surgery interventions for patients with fragility hip fractures. Among the 109 RCTs, 63% of the identified RCTs (n = 69) were related to rehabilitation or medication/nutrition supplementation, with the remaining RCTs focusing on osteoporosis management, optimization of clinical management, prevention of venous thromboembolism, fall prevention, multidisciplinary approaches, discharge support, management of post-operative anemia as well as group learning and motivational interviewing. For the interventions conducted in inpatient and outpatient settings investigating medication/nutrition supplementation, all reported improvement in outcomes (ranging from reduced postoperative complications, reduced length of hospital stay, improved functional recovery, reduced mortality rate, improved bone mineral density and reduced falls), except for a study investigating anabolic steroids. RCTs involving post-discharge osteoporosis care management generally reported improved osteoporosis management except for a RCT investigating multidisciplinary post-fracture clinic led by geriatrician with physiotherapist and occupational therapist. The trials investigating group learning and motivational interviewing also reported positive outcome respectively. The other interventions yielded mixed results. The interventions in this review had minor or no side effects reported. CONCLUSIONS The identified RCTs regarding post-surgery interventions were heterogeneous in terms of type of interventions, settings and outcome measures. Combining interventions across inpatient and outpatient settings may be able to achieve better outcomes such as improved physical function recovery and improved nutritional status recovery. For example, nutritional supplementation could be made available for patients who have undergone hip fracture surgery in the inpatient settings, followed by post-discharge outpatient osteoporosis care management. The findings from this review can aid in clinical practice by allowing formulation of thematic program with combination of interventions as part of bundled care to improve outcome for patients who have undergone hip fracture surgery.
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Affiliation(s)
- Jie Kie Phang
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore
- Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore, Singapore
| | - Zhui Ying Lim
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
| | - Wan Qi Yee
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
| | - Cheryl Yan Fang Tan
- Bright Vision Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
| | - Yu Heng Kwan
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
- Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation (CPHRI), SingHealth Regional Health System, SingHealth, Singapore, Singapore.
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore.
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Post-Acute & Continuing Care, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168852, Singapore.
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Jiang Y, Wang M, Liu S, Ya X, Duan G, Wang Z. The association between sedentary behavior and falls in older adults: A systematic review and meta-analysis. Front Public Health 2022; 10:1019551. [PMID: 36438277 PMCID: PMC9691853 DOI: 10.3389/fpubh.2022.1019551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background It is generally believed that sedentary behavior (SB) increases the risk of falls among older adults, but the evidence for it remains inconsistent and scarce. Purpose Our study aims to provide a systematic review and meta-analysis of available evidence regarding the association of SB with falls in older adults. Method A comprehensive search strategy was conducted using several online databases from 1906 to March 2022. Cohort studies both concerning the association between SB and falls and involving participants over 60 years old were regarded as eligible for inclusion. Evidence was pooled by a random-effects meta-analysis. Quality assessment for individual studies was performed with the Newcastle-Ottawa Scale (NOS). Results Altogether seven publications were identified, and the age of the 24,750 individuals involved ranging from 60 to 99 years old. Overall quality of the included studies was rated as moderate-to-high quality. We found that SB was significantly associated with increased risk of falls compared with non-SB among older adults [Odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.07-1.28; I 2 = 46.90%, P heterogeneity = 0.07, random model]. Subgroup analyses that stratified the studies according to NOS score showed significant differences between groups. Subgroup analysis stratified by SB measurement, sample size, region, publication year, and follow-up duration showed no significant differences between groups. Conclusion The findings provide reliable support for the hypothesis that sedentary lifestyles are strong predictors of falls among older adults, offering critical indications to develop strategies for fall prevention.
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Affiliation(s)
- YueShuai Jiang
- School of Sports Management and Communication, Capital Institute of Physical Education and Sports, Beijing, China
| | - Mei Wang
- School of Dance and Martial Arts, Capital Institute of Physical Education and Sports, Beijing, China
| | - Shuang Liu
- Department of Physical Education, Beijing International Studies University, Beijing, China
| | - Xiao Ya
- Department of Physical Education, Beijing No. 2 Middle School, Beijing Economic-Technological Development Area School, Beijing, China
| | - GuanTing Duan
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - ZiPu Wang
- School of Sports Management and Communication, Capital Institute of Physical Education and Sports, Beijing, China,*Correspondence: ZiPu Wang
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de Souza LF, Danielewicz AL, Rech CR, d'Orsi E, Mendonça VA, Lacerda ACR, de Avelar NCP. How much time in sedentary behavior is associated with probable sarcopenia in older adults? Geriatr Nurs 2022; 48:127-131. [PMID: 36208539 DOI: 10.1016/j.gerinurse.2022.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
Sedentary activities, such as watching television and using the computer, are frequent conditions in older adults and can be associated with sarcopenia. The objectives of this study were: (a) to establish sedentary behavior (SB) cutoff values for screening probable sarcopenia in community-dwelling older adults and (b) to verify the association between SB and probable sarcopenia according to the established cutoff point. This was a cross-sectional study including 1,165 community residents in Florianopolis/SC. SB was assessed using the International Physical Activity Questionnaire. The outcome was probable sarcopenia (assessed by time ≥ 15 s in the Five times sit-to-stand test). The cut-off points found for SB were time > 120 min/day [AUC: 0.54 (95%CI: 0.51; 0.57)] watching TV or video/DVD and ≤ 20 min/day [AUC: 0.59 (95%CI: 0.56;0.62)] using computer/internet. Older adults with SB had 1.30 (95% CI: 1.01; 1.66) and 1.46 (95% CI: 1.08; 1.96) greater chances of having sarcopenia, respectively.
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Affiliation(s)
| | - Ana Lúcia Danielewicz
- Federal University of Santa Catarina, Department of Health Sciences, Araranguá, Brazil
| | - Cassiano Ricardo Rech
- Federal University of Santa Catarina, Department of Physical Education, Florianopolis, Brazil
| | - Eleonora d'Orsi
- Federal University of Santa Catarina, Department of Public Health, Florianopolis, Brazil
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Mugler N, Baurecht H, Lam K, Leitzmann M, Jochem C. The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10178. [PMID: 36011821 PMCID: PMC9408392 DOI: 10.3390/ijerph191610178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Sedentary behavior is an important risk factor for several chronic diseases and is associated with an increased risk of mortality. We assessed the effectiveness of interventions to reduce sedentary time in Germany and provide recommendations on interventions to reduce sedentary time in children and adults. METHODS We comprehensively searched PubMed, Web of Science and the German Clinical Trials Register up to April 2022 for intervention studies targeting sedentary behavior in Germany. We performed a systematic review and qualitative synthesis of the interventions and a meta-analysis in children. RESULTS We included 15 studies comprising data from 4588 participants. The results of included primary studies in adults and children showed inconsistent evidence regarding change in sedentary time, with a majority of studies reporting non-significant intervention effects. The meta-analysis in children showed an increase in sedentary time for children in the control and intervention groups. CONCLUSION We found inconsistent evidence regarding the effectiveness of interventions to reduce time spent sedentary and our meta-analysis showed an increase in sedentary time in children. For children, we recommend physical and social environment interventions with an active involvement of families. For adults, we recommend physical environment interventions, such as height-adjustable desks at work.
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Kaizu Y, Kasuga T, Takahashi Y, Otani T, Miyata K. Sleep Should Be Focused on When Analyzing Physical Activity in Hospitalized Older Adults after Trunk and Lower Extremity Fractures-A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10081429. [PMID: 36011086 PMCID: PMC9408561 DOI: 10.3390/healthcare10081429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Although the importance of resting in bed for hospitalized older adults is known, current methods of interpreting physical activity (PA) recommend the use of a broad definition of sedentary behavior (SB) that includes 0−1.5 metabolic equivalents (METs) of sleep (SL) and sitting. We investigated the characteristics of PA by conducting a cross-sectional study of 25 older adults with trunk and lower extremity fractures. The intensity of their PA was interpreted as SL (0−0.9 METs), SB (1−1.5 METs), low-intensity PA (LIPA: 1.6−2.9 METs), and moderate-to-vigorous PA (MVPA: >3.0 METs). We calculated the correlation coefficients to clarify the relationship between each PA intensity level. Our analyses revealed that the PA time (min/day) was accounted for by SB (53.5%), SL (23.2%), LIPA (22.8%), and MVPA (0.5%). We observed negative correlations between SL and SB (r = −0.837) and between SL and LIPA (r = −0.705), and positive correlations between SB and LIPA (r = 0.346) and between LIPA and MVPA (r = 0.429). SL and SB were also found to have different trends in relation to physical function. These results indicate that SL and SB are trade-offs for PA during the day. Separate interpretations of the SL and SB of older hospitalized adults are thus recommended.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Takeaki Kasuga
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, 2204 Yoshii-machi Maniwa, Takasaki, Gunma 370-2104, Japan;
| | - Yu Takahashi
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, 1373 Higashinagaoka-cho, Ota, Gunma 373-0812, Japan;
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, 4669-2 Ami-Machi, Inashiki-gun, Ibaraki 300-0394, Japan
- Correspondence: ; Tel.: +81-29-888-4000
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How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults? J Aging Phys Act 2021; 30:806-812. [PMID: 34911037 DOI: 10.1123/japa.2021-0175] [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: 05/15/2021] [Revised: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022]
Abstract
Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.
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Handoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2021; 11:CD007125. [PMID: 34766330 PMCID: PMC8586844 DOI: 10.1002/14651858.cd007125.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hip fracture is a major cause of morbidity and mortality in older people, and its impact on society is substantial. After surgery, people require rehabilitation to help them recover. Multidisciplinary rehabilitation is where rehabilitation is delivered by a multidisciplinary team, supervised by a geriatrician, rehabilitation physician or other appropriate physician. This is an update of a Cochrane Review first published in 2009. OBJECTIVES To assess the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older people with hip fracture. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE and Embase (October 2020), and two trials registers (November 2019). SELECTION CRITERIA We included randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older people (aged 65 years or over) with hip fracture. The primary outcome - 'poor outcome' - was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. The other 'critical' outcomes were health-related quality of life, mortality, dependency in activities of daily living, mobility, and related pain. DATA COLLECTION AND ANALYSIS Pairs of review authors independently performed study selection, assessed risk of bias and extracted data. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome. MAIN RESULTS The 28 included trials involved 5351 older (mean ages ranged from 76.5 to 87 years), usually female, participants who had undergone hip fracture surgery. There was substantial clinical heterogeneity in the trial interventions and populations. Most trials had unclear or high risk of bias for one or more items, such as blinding-related performance and detection biases. We summarise the findings for three comparisons below. Inpatient rehabilitation: multidisciplinary rehabilitation versus 'usual care' Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 20 trials. Multidisciplinary rehabilitation probably results in fewer cases of 'poor outcome' (death or deterioration in residential status, generally requiring institutional care) at 6 to 12 months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.80 to 0.98; 13 studies, 3036 participants; moderate-certainty evidence). Based on an illustrative risk of 347 people with hip fracture with poor outcome in 1000 people followed up between 6 and 12 months, this equates to 41 (95% CI 7 to 69) fewer people with poor outcome after multidisciplinary rehabilitation. Expressed in terms of numbers needed to treat for an additional harmful outcome (NNTH), 25 patients (95% CI 15 to 100) would need to be treated to avoid one 'poor outcome'. Subgroup analysis by type of multidisciplinary rehabilitation intervention showed no evidence of subgroup differences. Multidisciplinary rehabilitation may result in fewer deaths in hospital but the confidence interval does not exclude a small increase in the number of deaths (RR 0.77, 95% CI 0.58 to 1.04; 11 studies, 2455 participants; low-certainty evidence). A similar finding applies at 4 to 12 months' follow-up (RR 0.91, 95% CI 0.80 to 1.05; 18 studies, 3973 participants; low-certainty evidence). Multidisciplinary rehabilitation may result in fewer people with poorer mobility at 6 to 12 months' follow-up (RR 0.83, 95% CI 0.71 to 0.98; 5 studies, 1085 participants; low-certainty evidence). Due to very low-certainty evidence, we have little confidence in the findings for marginally better quality of life after multidisciplinary rehabilitation (1 study). The same applies to the mixed findings of some or no difference from multidisciplinary rehabilitation on dependence in activities of daily living at 1 to 4 months' follow-up (measured in various ways by 11 studies), or at 6 to 12 months' follow-up (13 studies). Long-term hip-related pain was not reported. Ambulatory setting: supported discharge and multidisciplinary home rehabilitation versus 'usual care' Three trials tested this comparison in 377 people mainly living at home. Due to very low-certainty evidence, we have very little confidence in the findings of little to no between-group difference in poor outcome (death or move to a higher level of care or inability to walk) at one year (3 studies); quality of life at one year (1 study); in mortality at 4 or 12 months (2 studies); in independence in personal activities of daily living (1 study); in moving permanently to a higher level of care (2 studies) or being unable to walk (2 studies). Long-term hip-related pain was not reported. One trial tested this comparison in 240 nursing home residents. There is low-certainty evidence that there may be no or minimal between-group differences at 12 months in 'poor outcome' defined as dead or unable to walk; or in mortality at 4 months or 12 months. Due to very low-certainty evidence, we have very little confidence in the findings of no between-group differences in dependency at 4 weeks or at 12 months, or in quality of life, inability to walk or pain at 12 months. AUTHORS' CONCLUSIONS In a hospital inpatient setting, there is moderate-certainty evidence that rehabilitation after hip fracture surgery, when delivered by a multidisciplinary team and supervised by an appropriate medical specialist, results in fewer cases of 'poor outcome' (death or deterioration in residential status). There is low-certainty evidence that multidisciplinary rehabilitation may result in fewer deaths in hospital and at 4 to 12 months; however, it may also result in slightly more. There is low-certainty evidence that multidisciplinary rehabilitation may reduce the numbers of people with poorer mobility at 12 months. No conclusions can be drawn on other outcomes, for which the evidence is of very low certainty. The generally very low-certainty evidence available for supported discharge and multidisciplinary home rehabilitation means that we are very uncertain whether the findings of little or no difference for all outcomes between the intervention and usual care is true. Given the prevalent clinical emphasis on early discharge, we suggest that research is best orientated towards early supported discharge and identifying the components of multidisciplinary inpatient rehabilitation to optimise patient recovery within hospital and the components of multidisciplinary rehabilitation, including social care, subsequent to hospital discharge.
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Affiliation(s)
- Helen Hg Handoll
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- Department of Orthopaedics and Trauma, The University of Edinburgh, Edinburgh, UK
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Terence P Finnegan
- Department of Aged Care and Rehabilitation Medicine, Royal North Shore Hospital of Sydney, St Leonards, Australia
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Morri M, Forni C, Guberti M, Chiari P, Pecorari A, Orlandi AM, Gazineo D, Bozzo M, Ambrosi E. Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study. Disabil Rehabil 2021; 44:4241-4248. [PMID: 33725460 DOI: 10.1080/09638288.2021.1897692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Health systems are using ever-increasing resources on treating hip fractures. Optimal post-hospital care needs to be defined to design an effective care pathway. The aim of the present study was to describe the post-hospital care pathway of individuals with hip fracture and to assess its association with the degree of recovery of independence achieved four months after surgery. MATERIALS AND METHODS A prognostic multicentric cohort study was conducted. All patients aged 65 years and over who were admitted with a diagnosis of fragility hip fracture were enrolled. After the hospital discharge, the patients were followed either at an inpatient rehabilitation facility with an intensive or extensive regimen, a nursing home, a long-term care facility or at home. Among the various care pathways, the intensity of rehabilitation differed according to its duration, frequency of sessions, and activities proposed. Primary outcome was the patient's degree of independence achieved four months after surgery, as measured with Activities of Daily Living scale. Several covariates were collected to test the correlation between the different post-hospital care pathways and the recovery of independence. RESULTS A total of 923 patients completed the follow-up. A post- hospital rehabilitation pathway was indicated for 88.2% of the patients. The extensive rehabilitation pathway, indicated for 36.7% of the patients, was the most common. The intensive rehabilitation pathway gave better results in terms of independence at four-month follow up, leading to a median ADL score of 1.4 (95% CI 1.0-2.0). The other care pathways did not show significant difference between each other. CONCLUSIONS High-intensity rehabilitation was associated to better results in terms of recovering of Activities of Daily Living.IMPLICATIONS FOR REHABILITATIONPost-hospital care pathways that include an intensive rehabilitation treatment should be improved/supported to make them available to a larger number of hip fracture patients.Patient selection criteria for post-hospital rehabilitation pathways should be standardized to optimize available healthcare resources.A cost-effectiveness analysis should be performed to analyze the economic sustainability of each post-hospital care pathway.
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Affiliation(s)
- Mattia Morri
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Cristiana Forni
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Monica Guberti
- Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Chiari
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italia
| | | | - Antonella Magli Orlandi
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Domenica Gazineo
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italia
| | - Maria Bozzo
- Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Ambrosi
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italia
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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Cook WL, Brasher PMA, Guy P, Bryan S, Donaldson MG, Sims-Gould J, McKay HA, Khan KM, Ashe MC. Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT. Gerontology 2020; 66:542-548. [PMID: 33176306 DOI: 10.1159/000510903] [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: 03/17/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. OBJECTIVE To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. METHODS A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3-12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0-12) at 12 months. RESULTS We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (n = 26) and usual care (UC, n = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI -0.3 to 2.0, p = 0.13). Adverse events were similar in the 2 groups. CONCLUSION The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.
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Affiliation(s)
- Wendy L Cook
- Division of Geriatric Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Providence Healthcare, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Pierre Guy
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada.,School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meghan G Donaldson
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada, .,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada,
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12
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More KM, Blanchard C, Theou O, Cranston A, Vinson AJ, Dipchand C, Kiberd B, Tennankore KK. A Location-Based Objective Assessment of Physical Activity and Sedentary Behavior in Ambulatory Hemodialysis Patients. Can J Kidney Health Dis 2019; 6:2054358119872967. [PMID: 31497306 PMCID: PMC6716178 DOI: 10.1177/2054358119872967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/25/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Dialysis patients have reduced moderate to vigorous physical activity, and
light physical activity. This has been shown in self-reported surveys and
objective accelerometer studies. Less attention has been directed toward
sedentary behavior, which is characterized by low energy expenditure (≤1.5
metabolic equivalents). Furthermore, locations where physical activity and
sedentary behavior occur are largely unknown for dialysis patients. Objectives: The objectives of this study were (1) to determine the minutes per day of
moderate to vigorous physical activity, light physical activity, and
sedentary behavior for hemodialysis patients; (2) to describe differences in
moderate to vigorous physical activity, light physical activity, and
sedentary behavior comparing dialysis versus nondialysis days; and (3) to
describe the locations where moderate to vigorous physical activity, light
physical activity, and sedentary behavior occur using global positioning
system (GPS) data. Design: Cross-sectional study. Setting: The study was performed at a tertiary care hospital in Nova Scotia,
Canada. Patients: A total of 50 adult in-center hemodialysis patients consented to the
study. Measurements: Physical activity and sedentary behavior were measured with an Actigraph-GT3X
accelerometer. Location was determined using a Qstarz BT-Q1000X GPS
receiver. Methods: Minutes of daily activity were described as was percentage of wear time for
each activity level across different locations during waking hours. Physical
activity intensity, quantity, and location were also analyzed according to
dialysis vs nondialysis days. Results: Forty-three patients met requirements for accelerometer analysis, of whom 42
had GPS data. Median wear time was 836.5 min/day (interquartile range [IQR]:
788.3-918.3). Median minutes of daily wear time spent in sedentary behavior,
light physical activity, and moderate to vigorous physical activity was 636
minutes (IQR: 594.1-730.1), 178 minutes (IQR: 144-222.1), and 1.6 minutes
(IQR: 0.6-7.7), respectively. Proportion of daily wear time spent in
sedentary behavior, light physical activity, and moderate to vigorous
physical activity was 78.4% (IQR: 70.7-84.0), 21.5% (IQR: 16.0-26.9), and
0.2% (IQR: 0.1-1.1), respectively. Home was the dominant location for total
linked accelerometer-GPS time (59.4%, IQR: 46.9-69.5) as well as for each
prespecified level of activity. Significantly more sedentary behavior and
less light physical activity occurred on dialysis days compared with
nondialysis days (P ≤ .01, respectively). Moderate to
vigorous physical activity did not differ significantly between dialysis and
nondialysis days. Limitations: Small sample size from a single academic center may limit generalizability.
Difficult to engage population as less than half of eligible dialysis
patients provided consent. Physical activity may have been underestimated as
devices were not worn for all waking hours or aquatic activities, and
hip-based accelerometers may not capture stationary exercise. Conclusions: Ambulatory, in-center hemodialysis patients exhibit substantial sedentary
behavior and minimal physical activity across a limited range of locations.
Given the sedentary tendencies of this population, focus should be directed
on increasing physical activity at any location frequented. Home-based
exercise programs may serve as a potential adjunct to established
intradialytic-based therapies given the amount of time spent in the home
environment.
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Affiliation(s)
- Keigan M More
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Chris Blanchard
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.,School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Amanda J Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Christine Dipchand
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Bryce Kiberd
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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13
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Ashe MC, Michalowski VI, Chudyk AM, Gerstorf D, Madden KM, Hoppmann CA. Linked Lives: Exploring Gender and Sedentary Behaviors in Older Adult Couples. J Appl Gerontol 2019; 39:1106-1114. [PMID: 31441353 DOI: 10.1177/0733464819868060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: We explored associations between co-habiting partners for sedentary behavior (type and time, via accelerometry and self-report), gender, and a surrogate health measure (inflammatory biomarker: C-reactive protein, CRP). Methods: Participants completed activity questionnaires and the Timed Up and Go (mobility), wore an accelerometer for 7 days, and provided samples for high-sensitivity (hs) CRP. We used multilevel modeling (partners within couples) to investigate associations between independent variables and (a) sedentary behavior and (b) hsCRP. Results: 112 couples (50% women) provided sedentary data and hsCRP. Sedentary behavior was significantly correlated (r = .440, p < .001) between women and men, but there were significant differences in sedentary time (women < men) and light activity (women > men). Gender, moderate to vigorous physical activity (MVPA), and mobility estimated 37% of the modeled variance in sedentary time, while body mass index (BMI) and MVPA estimated 10% of the modeled variance in hsCRP. Discussion: Despite differences in how activity was accumulated, there were no significant differences between women's and men's health biomarker.
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Affiliation(s)
- Maureen C Ashe
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada.,The University of British Columbia, Vancouver, Canada.,The University of Adelaide, Adelaide, Australia
| | | | - Anna M Chudyk
- University of Manitoba, Winnipeg, Canada.,Manitoba SPOR Primary and Integrated Healthcare Innovation Network, Winnipeg, Canada
| | | | - Kenneth M Madden
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada.,The University of British Columbia, Vancouver, Canada
| | - Christiane A Hoppmann
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada.,Department of Psychology, University of British Columbia
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