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Backman C, Engel FD, Webber C, Harley A, Tanuseputro P, de Mello ALSF, Lanzoni GMDM, Papp S. Barriers to Discharge of Hip Fracture Patients From An Academic Hospital: A Retrospective Data Analysis. Geriatr Orthop Surg Rehabil 2024; 15:21514593241273170. [PMID: 39156481 PMCID: PMC11329904 DOI: 10.1177/21514593241273170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada. Methods We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery). Results A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR .50, 95% CI .32;.79) compared to a weekday, patients had a total hip replacement (OR .28, 95% CI .10;.80) or dynamic hip screw fixation (OR .49, 95% CI .25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR .05, 95% CI .02;.13), home (OR .26, 95% CI .15;.46), or transferred to another specialty in the hospital (OR .49, 95% CI .29;.84) compared to inpatient rehabilitation. Conclusions Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | | | - Anne Harley
- Geriatric Rehabilitation, Bruyère Continuing Care, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Steve Papp
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
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Ogawa T, Onuma R, Sagae H, Schermann H, Kristensen MT, Fushimi K, Yoshii T, Jinno T. Association between additional weekend rehabilitation and functional outcomes in patients with hip fractures: does age affect the effectiveness of weekend rehabilitation? Eur Geriatr Med 2024; 15:1091-1100. [PMID: 38703245 DOI: 10.1007/s41999-024-00980-5] [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: 10/01/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Rehabilitation after hip fracture surgery is crucial for improving physical function. Additional rehabilitation over the weekend or after working hours is reportedly associated with improved physical function; however, this may not apply to an aging population, including patients aged > 90 years. This study aimed to investigate the association between additional weekend rehabilitation and functional outcomes in different age groups. METHODS This study analyzed a cohort of patients aged ≥ 60 years who had hip fractures and were operated on from 2010 to 2018. Data were extracted from a nationwide multicentre database. Functional outcomes at discharge were compared between patients who underwent rehabilitation on weekdays only and those who underwent rehabilitation on both weekdays and weekends. The patient groups were selected using propensity score matching analysis. Furthermore, a subgroup-analysis was conducted on patients in their 60 s, 70 s, 80 s, and 90 s. RESULTS A total of 390,713 patients underwent surgery during the study period. After matching, each group comprised 129,583 pairs of patients. Patients who underwent weekend rehabilitation exhibited improved physical function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15-1.19], 1.17 [1.15-1.2], and 1.06 [1.03-1.08], respectively). In subgroup analysis, except for stair climbing, the positive association between weekend rehabilitation and patient function was observed across all age groups. CONCLUSION Weekend rehabilitation was significantly associated with improved physical function. Given the limited healthcare resources, high-demand activities such as stair climbing may be reserved for younger age groups to optimise rehabilitation therapy.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Ryo Onuma
- Department of Rehabilitation, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Hiromori Sagae
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Haggai Schermann
- Division of Orthopaedic Surgery, Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Netanya, Israel
- Laniado Hospital, Sanz Medical Center, Affiliated with Ariel University, Ariel, Israel, Divrei Khayim St 16, 4244916, Netanya, Israel
| | - Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Nielsine Nielsens Vej 10, 2400, Copenhagen NV, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1 Chome-5-45 Yushima, Bunkyo, Tokyo, 113-8510, Japan.
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Dissaneewate K, Dissaneewate P, Orapiriyakul W, Kritsaneephaiboon A, Chewakidakarn C. Development and Validation of Two-Step Prediction Models for Postoperative Bedridden Status in Geriatric Intertrochanteric Hip Fractures. Diagnostics (Basel) 2024; 14:804. [PMID: 38667450 PMCID: PMC11049116 DOI: 10.3390/diagnostics14080804] [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: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with intertrochanteric hip fractures are at an elevated risk of becoming bedridden compared with those with intraarticular hip fractures. Accurate risk assessments can help clinicians select postoperative rehabilitation strategies to mitigate the risk of bedridden status. This study aimed to develop a two-step prediction model to predict bedridden status at 3 months postoperatively: one model (first step) for prediction at the time of admission to help dictate postoperative rehabilitation plans; and another (second step) for prediction at the time before discharge to determine appropriate discharge destinations and home rehabilitation programs. Three-hundred and eighty-four patients were retrospectively reviewed and divided into a development group (n = 291) and external validation group (n = 93). We developed a two-step prediction model to predict the three-month bedridden status of patients with intertrochanteric fractures from the development group. The first (preoperative) model incorporated four simple predictors: age, dementia, American Society of Anesthesiologists physical status classification (ASA), and pre-fracture ambulatory status. The second (predischarge) model used an additional predictor, ambulation status before discharge. Model performances were evaluated using the external validation group. The preoperative model performances were area under ROC curve (AUC) = 0.72 (95%CI 0.61-0.83) and calibration slope = 1.22 (0.40-2.23). The predischarge model performances were AUC = 0.83 (0.74-0.92) and calibration slope = 0.89 (0.51-1.35). A decision curve analysis (DCA) showed a positive net benefit across a threshold probability between 10% and 35%, with a higher positive net benefit for the predischarge model. Our prediction models demonstrated good discrimination, calibration, and net benefit gains. Using readily available predictors for prognostic prediction can assist clinicians in planning individualized postoperative rehabilitation programs, home-based rehabilitation programs, and determining appropriate discharge destinations, especially in environments with limited resources.
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Affiliation(s)
- Kantapon Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
- Department of Clinical Research and Medical Data Science, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Pornpanit Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Wich Orapiriyakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Apipop Kritsaneephaiboon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
| | - Chulin Chewakidakarn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkhla University, Hat Yai 90110, Thailand; (P.D.); (W.O.); (A.K.); (C.C.)
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Sermon A, Verhulst E, Aerden L, Hoekstra H. A retrospective chart analysis with 5-year follow-up of early care for geriatric hip fracture patients: why we should continue talking about hip fractures. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02514-x. [PMID: 38592463 DOI: 10.1007/s00068-024-02514-x] [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: 12/24/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Timing of surgery remains a topic of debate for hip fracture treatment in the geriatric patient population. The quality indicator "early surgery" was implemented in 2014 at the Department of Trauma Surgery of the University Hospitals Leuven to enhance timely operative treatment. In this follow-up study, we aim to evaluate the performance of this quality indicator, the clinical outcomes, and room for improvement. METHODS The charts of 1190 patients surgically treated for an acute hip fracture were reviewed between June 2017 and May 2022 at the University Hospitals Leuven. Primary endpoints were adherence to early surgery, defined as surgery within the next calendar day, and the evaluation of the reasons for deviating from this protocol. Secondary endpoints were length of stay (LOS); intensive care unit (ICU) admission and length of ICU stay; mortality after 30 days, 60 days, 90 days, and 6 months; and 90-day readmission rate. Pearson's Chi-square test and Mann-Whitney U test were used for data analysis. RESULTS One thousand eighty-four (91.1%) patients received early surgery versus 106 (8.9%) patients who received delayed surgery. The main reasons for surgical delay were the use of anticoagulants (33%), a general health condition not allowing safe surgery and/or existing comorbidities requiring workup prior to surgery (26.4%), and logistical reasons (17.9%). Patient delay and transfer from other hospitals were responsible for respectively 8.5% and 6.6% of delayed surgery. Early surgery resulted in a significantly shorter LOS and ICU stay (12 [8-25] vs. 18 [10-36] and 3 [2-6] vs. 7 [3-13] days, early vs. delayed surgery, respectively). No significant reduction was observed in ICU admission, mortality, and readmission rate. CONCLUSION We have been able to maintain the early surgery hip fracture protocol in approximately 90% of the patients. Comorbidities and anticoagulant use were responsible for delayed surgery in the majority of the patients. Correct implementation of the existing protocol on anticoagulant use could lead to a one-third decrease in the number of delayed surgeries. Subsequently, since the LOS and ICU stay in the delayed surgery group were significantly longer, a further increase of early surgery will lower the current economic burden.
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Affiliation(s)
- An Sermon
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Evelyne Verhulst
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens Aerden
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
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Ghai S, Chassé K, Renaud MJ, Guicherd-Callin L, Bussières A, Zidarov D. Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation. BMC Health Serv Res 2024; 24:421. [PMID: 38570840 PMCID: PMC10993552 DOI: 10.1186/s12913-024-10818-2] [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: 07/11/2023] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home. METHODS A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults. RESULTS Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs. CONCLUSION Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program. CLINICAL TRIAL REGISTRATION Retrospectively registered NCT05915156 (22/06/2023).
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden.
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden.
| | - Kathleen Chassé
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - Marie-Jeanne Renaud
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - Lilian Guicherd-Callin
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montréal, Québec, Canada
- Departement Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Diana Zidarov
- Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
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6
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Ishikawa Y, Adachi T, Uchiyama Y. Association of Nutritional Risk With Gait Function and Activities of Daily Living in Older Adult Patients With Hip Fractures. Ann Rehabil Med 2024; 48:115-123. [PMID: 38644638 PMCID: PMC11058366 DOI: 10.5535/arm.230015] [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: 11/02/2023] [Revised: 02/17/2024] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To investigate the association of nutritional risk with gait function and activities of daily living (ADLs) in older adult patients with hip fractures. METHODS The retrospective data of older adult patients diagnosed with hip fractures who visited the recovery-phase rehabilitation ward between January 2019 and December 2022 were reviewed. Nutritional risk was evaluated using the Geriatric Nutritional Risk Index; gait function and ADLs were assessed using the modified Harris Hip Score subitem and Functional Independence Measure, respectively. Multivariate linear regression and path analysis with structural equation modeling were used to examine the factors associated with ADLs and the associations among the study variables. RESULTS This study included 206 participants (172 females and 34 males; mean age, 85.0±7.3 years). In the multivariate analysis, gait function (β=0.488, p<0.001), cognitive function (β=0.430, p<0.001), and surgery (β=-0.143, p<0.001) were identified as independent factors. Pathway analysis revealed that nutritional risk was not directly correlated with ADLs but was directly associated with gait and cognitive functions. Gait and cognitive functions, in turn, were directly related to ADLs. CONCLUSION Nutritional risk was found to be associated with ADLs through an intermediary of gait and cognitive functions.
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Affiliation(s)
- Yasunobu Ishikawa
- Department of Rehabilitation, Nishio Hospital, Nishio, Japan
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takuji Adachi
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yasushi Uchiyama
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Juffermans NP, Gözden T, Brohi K, Davenport R, Acker JP, Reade MC, Maegele M, Neal MD, Spinella PC. Transforming research to improve therapies for trauma in the twenty-first century. Crit Care 2024; 28:45. [PMID: 38350971 PMCID: PMC10865682 DOI: 10.1186/s13054-024-04805-6] [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: 12/31/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
Improvements have been made in optimizing initial care of trauma patients, both in prehospital systems as well as in the emergency department, and these have also favorably affected longer term outcomes. However, as specific treatments for bleeding are largely lacking, many patients continue to die from hemorrhage. Also, major knowledge gaps remain on the impact of tissue injury on the host immune and coagulation response, which hampers the development of interventions to treat or prevent organ failure, thrombosis, infections or other complications of trauma. Thereby, trauma remains a challenge for intensivists. This review describes the most pressing research questions in trauma, as well as new approaches to trauma research, with the aim to bring improved therapies to the bedside within the twenty-first century.
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Affiliation(s)
- Nicole P Juffermans
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Tarik Gözden
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Ross Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Jason P Acker
- Canadian Blood Services, Innovation and Portfolio Management, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Michael C Reade
- Medical School, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Marc Maegele
- Department of Trauma and Orthopedic Surgery Cologne-Merheim Medical Center Institute of Research, Operative Medicine University Witten-Herdecke, Cologne, Germany
| | - Matthew D Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang J, He C. Evidence-based rehabilitation medicine: definition, foundation, practice and development. MEDICAL REVIEW (2021) 2024; 4:42-54. [PMID: 38515780 PMCID: PMC10954297 DOI: 10.1515/mr-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/19/2023] [Indexed: 03/23/2024]
Abstract
To determine the definition, foundation, practice, and development of evidence-based rehabilitation medicine (EBRM) and point out the development direction for EBRM. Retrieve the database of PubMed, Cochrane Library, Embase, China national knowledge infrastructure (CNKI), Wanfang, and China science and technology journal database (CSTJ). The search was conducted from the establishment of the database to June 2023. The key words are "rehabilitation medicine and evidence based" in Chinese and English. After reading the abstract or full text of the literature, a summary analysis is conducted to determine the definition, foundation, practice, and development of EBRM. A total of 127 articles were included. The development of 14 sub majors in EBRM are not balanced, evidence-based musculoskeletal rehabilitation medicine (EBMRM) (31 articles, mainly focuses on osteoarthritis, osteoporosis and musculoskeletal pain), evidence-based neurorehabilitation medicine (EBNM) (34 articles, mainly concentrated in stroke, traumatic brain injury and spinal cord injury) and evidence-based education rehabilitation medicine (EBEDRM) (17 articles, mainly focuses on educational methodology), evidence-based nursing rehabilitation medicine (EBNRM) (2 articles), evidence-based engineering rehabilitation medicine (EBENRM) (7 articles), evidence-based traditional Chinese rehabilitation medicine (EBTCRM) (3 articles), evidence-based internal rehabilitation medicine (EBIRM) (11 articles), evidence-based intensive care rehabilitation medicine (EBICRM) (4 articles), evidence-based oncology rehabilitation medicine (EBORM) (6 articles), evidence-based physical therapy medicine (EBPTM) (3 articles), evidence-based cardiopulmonary rehabilitation medicine (EBCRM) (6 articles), evidence-based speech therapy medicine (EBSTM)/evidence-based occupation therapy medicine (EBOTM)/evidence-based geriatric rehabilitation medicine (EBGRM) (1 article). The EBMRM, EBNM and EBEDRM are relatively well developed. The development of EBNRM, EBENRM, EBTCRM, EBIRM, EBICRM, EBGRM, EBORM, EBCRM, EBPTM, EBSTM and EBOTM is relatively slow, indicating these eleven fields should be pay more attention in future.
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Affiliation(s)
- Jinlong Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Milton-Cole R, Kazeem K, Gibson A, Guerra S, Sheehan KJ. Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis. Osteoporos Int 2024; 35:227-242. [PMID: 37831102 DOI: 10.1007/s00198-023-06923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
This study determines the effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults after hip fracture. Ovid MEDLINE, Embase, Global Health, APAPsych, CENTRAL, CIHAHL, PEDro and Open Grey were searched from database inception to June 10, 2022 for definitive, pilot or feasibility randomised controlled trials of rehabilitation interventions (versus any comparator) which reported depressive symptoms among older adults post hip fracture. Nonrandomised trials and those not published in English were excluded. Selection, quality appraisal (Cochrane Risk of Bias 2) and extraction in duplicate. Results were synthesised narratively and with meta-analysis (Hedge's g for intervention effect, I2 for heterogeneity). Eight trials (1146 participants) were included. Interventions were predominantly face-to-face exercise rehabilitation (range three to 56 sessions) at home versus usual care. Three trials were assigned overall low risk of bias, three some concerns and two high risk. The pooled effect of rehabilitation on depressive symptoms at intervention end favoured the intervention group (Hedges's g -0.43; 95% CI: -0.87, 0.01; four trials). Three trials demonstrated no between group difference following adjustment for baseline depressive symptoms. One trial found lower odds of depression when the intervention additionally included falls prevention, nutrition consultation and depression management. There is a potential benefit of exercise rehabilitation interventions on depressive symptoms after hip fracture. A mechanism for benefit may relate to baseline symptom severity, exercise frequency, frequency of health professional contacts, addition of a psychological component or of the quality of the underlying trials. To appropriately inform clinical guidelines, further appropriately powered trials with follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42022342099.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kareema Kazeem
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Alexander Gibson
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.
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Soukkio PK, Suikkanen SA, Sintonen H, Kukkonen-Harjula KT, Kautiainen H, Kääriä SM, Hupli MT, Aartolahti EM, Pitkälä KH, Sipilä S. Health-related quality of life after hip fracture: effects of a 12-month home-based exercise intervention-secondary analyses of an RCT. Qual Life Res 2024; 33:541-550. [PMID: 37932555 DOI: 10.1007/s11136-023-03545-4] [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] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE In this randomized controlled trial, we analyzed the effects of a 12-month home-based exercise intervention on the health-related quality of life (HRQoL) of patients with a hip fracture. METHODS Participants (n = 121) aged ≥ 60 years, with a Mini-Mental State Examination (MMSE) score of ≥ 12 and an operated hip fracture, were placed into Exercise (n = 61) or Usual care (n = 60) groups. Physiotherapist-supervised, home-based training was given twice a week over 12 months. HRQoL was assessed using the 15D instrument at baseline and at 3, 6, and 12 months. The total 15D scores and dimension scores were analyzed and compared to national age- and sex-matched reference data. RESULTS The participants' mean age was 81 years (SD 7), 75% were women, and 61% had a femoral neck fracture. The mean within-group change in total 15D score over 12 months was 0.023 (95% CI: -0.003 to 0.048) in the Usual care group, and 0.028 (CI: 0.003 to 0.054) in the Exercise group (between-group p = 0.76). We found a statistically significant change in total 15D score in the Exercise group, as well as in the dimension scores of mobility and usual activities in both groups. All 15D scores remained below the general population reference level. CONCLUSION Exercise training for 12 months did not enhance the HRQoL of home-dwelling patients with hip fractures any more than usual care. In addition, HRQoL remained below the population level in both groups.
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Affiliation(s)
- Paula K Soukkio
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland.
- Development Services, Wellbeing Services County of South Karelia, Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland.
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland.
| | - Sara A Suikkanen
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
- Faculty of Health Care and Social Services, LAB University of Applied Sciences, Yliopistonkatu 36, 53850, Lappeenranta, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO Box 20, 00014, Helsinki, Finland
| | - Katriina T Kukkonen-Harjula
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Folkhälsan Research Center, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Sanna M Kääriä
- Raatimiehet Oy, Raatimiehenkatu 18, 53100, Lappeenranta, Finland
| | - Markku T Hupli
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
| | - Eeva M Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Piippukatu 2, 40100, Jyväskylä, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00290, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Tukholmankatu 8 B, 00290, Helsinki, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland
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11
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Taraldsen K, Polhemus A, Engdal M, Jansen CP, Becker C, Brenner N, Blain H, Johnsen LG, Vereijken B. Evaluation of mobility recovery after hip fracture: a scoping review of randomized controlled studies. Osteoporos Int 2024; 35:203-215. [PMID: 37801082 PMCID: PMC10837269 DOI: 10.1007/s00198-023-06922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
Few older adults regain their pre-fracture mobility after a hip fracture. Intervention studies evaluating effects on gait typically use short clinical tests or in-lab parameters that are often limited to gait speed only. Measurements of mobility in daily life settings exist and should be considered to a greater extent than today. Less than half of hip fracture patients regain their pre-fracture mobility. Mobility recovery is closely linked to health status and quality of life, but there is no comprehensive overview of how gait has been evaluated in intervention studies on hip fracture patients. The purpose was to identify what gait parameters have been used in randomized controlled trials to assess intervention effects on older people's mobility recovery after hip fracture. This scoping review is a secondary paper that identified relevant peer-reviewed and grey literature from 11 databases. After abstract and full-text screening, 24 papers from the original review and 8 from an updated search and manual screening were included. Records were eligible if they included gait parameters in RCTs on hip fracture patients. We included 32 papers from 29 trials (2754 unique participants). Gait parameters were primary endpoint in six studies only. Gait was predominantly evaluated as short walking, with gait speed being most frequently studied. Only five studies reported gait parameters from wearable sensors. Evidence on mobility improvement after interventions in hip fracture patients is largely limited to gait speed as assessed in a controlled setting. The transition from traditional clinical and in-lab to out-of-lab gait assessment is needed to assess effects of interventions on mobility recovery after hip fracture at higher granularity in all aspects of patients' lives, so that optimal care pathways can be defined.
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Affiliation(s)
- K Taraldsen
- Department of Rehabilitation Science and Health Technology, OsloMet, Oslo, Norway.
| | - A Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Engdal
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - C-P Jansen
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - N Brenner
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital and Montpellier University MUSE, Montpellier, France
| | - L G Johnsen
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
- Department of Orthopaedic Surgery, St. Olav's Hospital HF, Trondheim, Norway
| | - B Vereijken
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
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12
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [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: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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13
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Shimizu T, Kanai C, Asakawa Y. Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case-control study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2070. [PMID: 38284469 DOI: 10.1002/pri.2070] [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: 08/10/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND PURPOSE Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence. METHODS This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65 years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity. RESULTS The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135 s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76). DISCUSSION The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.
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Affiliation(s)
- Tomoko Shimizu
- Department of Rehabilitation, Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Chiaki Kanai
- Department of Rehabilitation, Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Yasuyoshi Asakawa
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
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14
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Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
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Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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15
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Alito A, Fenga D, Portaro S, Leonardi G, Borzelli D, Sanzarello I, Calabrò RS, Milone D, Tisano A, Leonetti D. Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study. Folia Med (Plovdiv) 2023; 65:879-884. [PMID: 38351775 DOI: 10.3897/folmed.65.e99513] [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: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy.
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16
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Kaiser V, Fichtner UA, Schmuker C, Günster C, Rau D, Staab L, Farin-Glattacker E. A cross-sectoral approach to utilizing health claims data for quality assurance in medical rehabilitation: study protocol of a combined prospective longitudinal and retrospective cohort study. BMC Health Serv Res 2023; 23:1110. [PMID: 37848889 PMCID: PMC10583441 DOI: 10.1186/s12913-023-10074-w] [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: 07/07/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Measuring the quality of provided healthcare presents many challenges, especially in the context of medical rehabilitation. Rehabilitation is based on a holistic biopsychosocial model of health that includes a person's long-term functioning; hence, outcome domains are very diverse. In Germany, rehabilitation outcomes are currently assessed via patient and physician surveys. Health insurance claims data has the potential to simplify current quality assurance procedures in Germany, since its comprehensive collection is federally mandated from every healthcare provider. By using a cross-sectoral approach, quality assessments in rehabilitation can be adjusted for the quality provided in previous sectors and individual patient risk factors. METHODS SEQUAR combines two studies: In a prospective longitudinal study, 600 orthopedic rehabilitation patients and their physicians are surveyed at 4 and 2 time points, respectively, throughout rehabilitation and a follow-up period of 6 months. The questionnaires include validated instruments used in the current best-practice quality assurance procedures. In a retrospective cohort study, a nationwide claims database with more than 312,000 orthopedic rehabilitation patients will be used to perform exploratory analysis for the identification of quality indicators. The identified SEQUAR claims data quality indicators will be calculated for our prospective study participants and tested for their ability to approximate or replace the currently used, best-practice quality indicators based on primary data. DISCUSSION The identified SEQUAR quality indicators will be used to draft a novel, state-of-the-art quality assurance procedure that reduces the administrative burden of current procedures. Further research into the applicability to other indications of rehabilitation is required. TRIAL REGISTRATION WHO UTN: U1111-1276-7141; DRKS-ID: DRKS00028747 (Date of Registration in DRKS: 2022/08/10).
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Affiliation(s)
- Vanessa Kaiser
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Urs A Fichtner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | | | - Diana Rau
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Lena Staab
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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17
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Che YJ, Qian Z, Chen Q, Chang R, Xie X, Hao YF. Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients. BMC Musculoskelet Disord 2023; 24:817. [PMID: 37838680 PMCID: PMC10576877 DOI: 10.1186/s12891-023-06806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/17/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Exercise rehabilitation training is an important measure for improving the prognosis of patients with hip fractures. However, the particular program that works effectively and the efficiency of exercise therapy are still controversial. OBJECTIVE To compare the effects of usual postoperative care combined with rehabilitation based on exercise prescription on motor function and complications in elderly patients who underwent surgery for hip fracture. METHODS This was an observational study. A total of 71 elderly patients with hip fractures who were treated with hip arthroplasty and internal fixation of the proximal femur with an intramedullary nail at Suzhou Municipal Hospital from October 2020 to December 2021 were included; 11 cases were excluded (eight cases were excluded due to loss of follow-up, two due to deaths from other causes, and one due to other reasons). Finally, 60 patients (18 males and 42 females) were included. Patients were randomly assigned to the control (n = 30) and experimental (n = 30) groups using a random number generator. Patients in the control group received usual postoperative care, whereas those in the experimental group received usual postoperative care combined with rehabilitation training based on the principles of exercise prescription. We recorded the motor function (Harris hip score), daily living ability (Barthel Index), and complications at discharge and 1, 3, and 6 months postoperatively for statistical analysis. RESULTS The Harris hip score and Barthel Index score were significantly higher at 1, 3, and 6 months postoperatively than at discharge in both groups (p < 0.05). The Harris hip score and Barthel Index score at discharge and 1, 3, and 6 months postoperatively were significantly higher in the experimental group than in the control group (p < 0.05). The incidence of complications at 6 months postoperatively was significantly lower in the experimental group than in the control group (13% vs. 37%). CONCLUSIONS Rehabilitation therapy based on exercise prescription helps improve hip function and the ability to perform activities of daily living and related postoperative complications after hip fracture surgery in elderly patients. The findings of our study will guide decision-making in clinical practice and improve the clinical management of hip fractures in elderly patients postoperatively.
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Affiliation(s)
- Yan-Jun Che
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Zongna Qian
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Qi Chen
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Rui Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Xiaofeng Xie
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China
| | - Yue Feng Hao
- Orthopedics and Sports Medicine Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215008, China.
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Milton-Cole R, O'Connell MDL, Sheehan KJ, Ayis S. The role of depression in the association between physiotherapy frequency and duration and outcomes after hip fracture surgery: secondary analysis of the physiotherapy hip fracture sprint audit. Eur Geriatr Med 2023; 14:999-1010. [PMID: 37329488 PMCID: PMC10587201 DOI: 10.1007/s41999-023-00808-8] [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] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE It is not known whether the association between the frequency and duration of physiotherapy and patient outcomes varies for those with and without depression. This study aims to evaluate whether the associations between the frequency and duration of physiotherapy after hip fracture surgery and discharge home, surviving at 30 days post-admission, and being readmitted 30 days post discharge vary by depression diagnosis. METHODS Data were from 5005 adults aged 60 and over included in the UK Physiotherapy Hip Fracture Sprint Audit who had undergone surgery for a nonpathological first hip fracture. Logistic regression models were used to estimate the unadjusted and adjusted odds ratios and their 95% confidence intervals for the associations between physiotherapy frequency and duration and outcomes. RESULTS Physiotherapy frequency and duration were comparable between patients with and without depression (42.1% and 44.6%). The average adjusted odds for a 30-min increase in physiotherapy duration for those with and without depression for discharge home were 1.05 (95% CI 0.85-1.29) vs 1.16 (95% CI 1.05-1.28, interaction p = 0.36), for 30-day survival were 1.26 (95% CI 1.06-1.50) vs 1.11 (95% CI 1.05-1.17, interaction p = 0.45) and for readmission were 0.89 (95% CI 0.81-0.98) vs 0.97 (95% CI 0.93-1.00, interaction p = 0.09). None of the interaction tests reached formal significance, but the readmission models were close (p = 0.09). CONCLUSION Results suggest physiotherapy duration may be negatively associated with readmission in those with depression but not those without depression, while no clear difference in the other outcomes was noted.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, 4th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
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19
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Frihagen F, Ranhoff AH. [Older patients who sustain fractures]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0566. [PMID: 37753750 DOI: 10.4045/tidsskr.23.0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
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20
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Morris H, Cameron C, Vanderboor C, Nguyen A, Londahl M, Harng Chong Y, Navarre P. Hip fractures in the older adult: orthopaedic and geriatric shared care model in Southland, New Zealand-a 5-year follow-up study. BMJ Open Qual 2023; 12:e002242. [PMID: 37783522 PMCID: PMC10565250 DOI: 10.1136/bmjoq-2022-002242] [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: 12/27/2022] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Neck of femur fractures are common with associated high morbidity and mortality rates. National standards include provision of orthogeriatric care to any patient with a hip fracture. This study assessed the outcomes at 5 years following implementation of a collaborative orthogeriatric service at Southland Hospital in 2012. METHODS Retrospective data were collected for patients aged 65 years and older admitted with a fragility hip fracture. Data were collated for 2011 (preimplementation) and 2017 (postimplementation). Demographic data and American Society of Anesthesiologists (ASA) scores were recorded to ensure comparability of the patient groups. Length of stay, postoperative complications and 30-day and 1-year mortality were assessed. RESULTS 74 admissions with mean age at surgery of 84.2 years in 2011 and 107 admissions with mean age of 82.6 years in 2017. There was a higher proportion of ASA 2 and ASA 3 patients in 2017 compared with 2011 (p=0.036). The median length of stay in the orthopaedic ward was unchanged in the two cohorts but there was a shorter median length of stay by 6.5 days and mean length of stay by 11 days in 2017 in the rehabilitation ward (p<0.001 for both median and mean). Through logistic regression controlling for age, sex and ASA score, there was a reduction in the odds of having a complication by 12% (p<0.001). The study was too small to undertake statistical testing to calculate significant difference in overall 30-day and 1-year mortality between the groups. CONCLUSION The orthogeriatric service has reduced the frequency of complications and length of stay on the rehabilitation ward 5 years following implementation.
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Affiliation(s)
- Holly Morris
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
| | - Claire Cameron
- Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Christina Vanderboor
- Department of Trauma and Orthopaedics, Southland Hospital, Invercargill, Southland, New Zealand
| | - Anh Nguyen
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital London, London, UK
| | - Monica Londahl
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Yih Harng Chong
- Department of Older Person Health, Waitemata District Health Board, Takapuna, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Pierre Navarre
- Department of Trauma and Orthopaedics, Southland Hospital, Invercargill, Southland, New Zealand
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Ge Y, Chen Y, Liu G, Zhu S, Li B, Tian M, Zhang J, Wu X, Yang M. Association Between Hip Bone Mineral Density and Mortality Risk After Hip Fracture: A Prospective Cohort Study. Calcif Tissue Int 2023; 113:295-303. [PMID: 37347299 PMCID: PMC10449952 DOI: 10.1007/s00223-023-01109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Factors related to mortality after osteoporotic hip fracture (HF) have been investigated intensively, except for proximal femoral bone mineral density (BMD), which is also the primary cause of osteoporosis. In this study, we aimed to investigate the association of hip BMD with mortality risk after HF. Four hundred and eleven elderly patients with HF in Beijing, China, were included and prospectively followed up with a median time of 3 years. At baseline, quantitative CT technique (QCT) was used to measure areal BMD (aBMD) of the unaffected hip. Areal BMDs of the total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter were analyzed with postoperative mortality as the primary outcome. A total of 394 patients (78.59 ± 7.59 years, 75.4% female) were included in our final analysis, with 86 (82.23 ± 7.00 years, 81.4% female) dead. All hip bone densities demonstrated a significant association with mortality risks in the unadjusted model, but only TR aBMD remained significantly correlated after adjusting for all covariates. Compared to the lower TR aBMD group, the higher TR aBMD group yielded significantly lower death risks (HR 0.21 95% CI 0.05-0.9, P = 0.036). Higher survival probabilities were observed for higher TH and TR aBMD in survival analysis (P < 0.001). Hip BMD, especially TR BMD assessed by QCT, is an independent risk factor for postoperative mortality following HF. QCT may present a promising avenue for opportunistic analysis in immobilized patients, providing valuable information for early detection and personalized interventions to enhance patient outcomes.
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Affiliation(s)
- Yufeng Ge
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yimin Chen
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Liu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Li
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Jing Zhang
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China.
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Solberg LB, Vesterhus EB, Hestnes I, Ahmed MV, Ommundsen N, Westberg M, Frihagen F. Comparing two different orthogeriatric models of care for hip fracture patients: an observational prospective cross-sectional study. BMJ Open Qual 2023; 12:e002302. [PMID: 37783524 PMCID: PMC10565326 DOI: 10.1136/bmjoq-2023-002302] [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: 02/01/2023] [Accepted: 08/09/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Patients with hip fractures are almost always operated with quite extensive surgery and are often frail with a high risk of complications, increased dependency, and death. Orthogeriatric interdisciplinary care has shown better results compared with orthopaedic care alone. The best way of delivering orthogeriatric care, however, is still largely unknown. It is believed that a high degree of integration and shared care is better than on-demand consultative services. We aimed to evaluate two different orthogeriatric models for patients with hip fracture. METHODS A prospective hip fracture quality database was used to evaluate two coexisting models of care from 2019 to 2021 in our hospital. An 'integrated care model' (ICM) was compared with a 'geriatric consult service' (GCS). RESULTS 516 patients were available for analysis, 360 from ICM and 156 from GCS. Mean age was 84 years. There were 370 (72%) women. American Society of Anesthesiologists class and prefracture cognitive impairment was similar between the groups. There were more patients with femoral neck fractures in the ICM group, and more patients were living independently prefracture. A logistic regression adjusting for the variables above showed that more patients in the ICM group were given a nerve block preoperatively (OR 2.0 (95% CI 1.31 to 2.97); p<0.01), had their urinary catheter removed the first day after surgery (OR 1.9 (95% CI 1.27 to 2.89); p<0.01), were mobilised to standing or seated in a chair beside the bed the first day after surgery (OR 1.5 (95% CI 1.03 to 2.30); p=0.033) and more ICM patients were considered for treatment against osteoporosis (OR 8.58 (95% CI 4.03 to 18.28); p<0.001). There were no significant differences in time to surgery, length of stay, discharge destination or mortality. CONCLUSION The ICM group performed equally good or better on all quality indicators than the GCS.
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Affiliation(s)
| | | | - Ingvild Hestnes
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Marc Vali Ahmed
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Nina Ommundsen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Marianne Westberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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23
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Yi Y, Lee Y, Kang S, Kwon YH, Seo YM, Baek JY, Jang IY, Lee E, Koh Y, Jung HW, Park CM. Unmet Needs and Barriers in Providing Hospital Care for Older Adults: A Qualitative Study Using the Age-Friendly Health System Framework. Clin Interv Aging 2023; 18:1321-1332. [PMID: 37588681 PMCID: PMC10426405 DOI: 10.2147/cia.s409348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose This study aims to identify unmet needs and barriers for improving inpatient care for older adults at an academic hospital in Korea by using a qualitative focus group design and the Age-Friendly Health Systems (AFHS) framework. Patients and Methods A total of 14 healthcare providers and employees participated in focus group interviews. Participants included medical doctors, registered nurses, a receptionist, a patient transporter, a pharmacist, a physical therapist, and a social worker. The data were analyzed qualitatively, as per the Consolidated Criteria for Reporting Qualitative Research guidelines. The analysis method encompassed a thematic framework analysis via the AFHS 4Ms framework, consisting of the four domains "What Matters", "Medication", "Mentation", and "Mobility". Results Multiple barriers and unmet needs were identified using the AFHS 4Ms framework in the provision of inpatient care for older adults at the hospital. The main barriers identified in the "What matters" domain are a lack of shared decision-making and individualized care plans, as well as economic and safety-conscious preferences among some older patients. In the "Medications" domain, the main barriers to providing adequate and safe pharmacotherapy include patient and caregiver-related factors, increased complexity of medication use, and lack of institutional support systems. In the "Mentation" domain, the main issues identified are communication barriers related to patients, caregiver factors, and insufficient delirium management due to a lack of adequate processes/environments such as delirium identification. In the "Mobility" domain, the main challenges include reduced mobility and geriatric complications, unnecessary mobility restrictions, and the increased risk of falls due to lack of resources and environmental factors. Conclusion The study highlighted the need for improvements in inpatient care for older adults at an academic hospital in Korea. Identified unmet needs and barriers can be used to guide a more patient-centered approaches for an age-friendly inpatient environment.
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Affiliation(s)
- Youngseok Yi
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Selin Kang
- Department of Economics, The Graduate School, Yonsei University, Seoul, South Korea
| | - Young Hye Kwon
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Yeon Mi Seo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, South Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chan Mi Park
- Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA, USA
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Pol M, Qadeer A, van Hartingsveldt M, Choukou MA. Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study. JMIR Rehabil Assist Technol 2023; 10:e44498. [PMID: 37463040 PMCID: PMC10394599 DOI: 10.2196/44498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identified as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. OBJECTIVE The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. METHODS We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. RESULTS The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. CONCLUSIONS Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals.
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Affiliation(s)
- Margriet Pol
- Amsterdam University of Applied Sciences, Research Group Occupational Therapy - Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam, Netherlands
- Amsterdam University Medical center, location Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Amarzish Qadeer
- Bimedical Engineering graduate program, University of Manitoba, Winnipeg, MB, Canada
| | - Margo van Hartingsveldt
- Amsterdam University of Applied Sciences, Research Group Occupational Therapy - Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam, Netherlands
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
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25
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Ben Natan M, Masarwa R, Yonai Y, Finkel B, Berkovich Y. Mortality, Survival, and Readmissions During a 12-Month Follow-Up After Hip Fracture: Inpatient Rehabilitation Versus Home Rehabilitation. Rehabil Nurs 2023; 48:140-144. [PMID: 37417864 DOI: 10.1097/rnj.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE This study compared readmissions, survival, and mortality during a 12-month follow-up period of inpatient rehabilitation and home rehabilitation for older persons who had experienced a hip fracture. METHODS This work was retrospective cohort research. Between January 1 and December 30, 2019, the medical records of 280 elderly patients who were admitted to a hospital with a hip fracture were analyzed. Of these patients, 74.3% received inpatient rehabilitation, whereas 25.7% received home rehabilitation. RESULTS In terms of readmissions and death, there were no appreciable differences between the inpatient rehabilitation and home rehabilitation groups. The patients in the inpatient rehabilitation group were older; more likely to need assistance with activities of daily living; and were taking, on average, more prescription drugs on a daily basis than those in the home rehabilitation group. CONCLUSIONS AND CLINICAL RELEVANCE In conclusion, as better outcomes were expected for the home rehabilitation group, which on average included less complicated patients, our findings suggest that the home rehabilitation pathway may not be a good alternative to the inpatient rehabilitation pathway.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rawan Masarwa
- Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Yonai
- Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Binyamin Finkel
- Orthopedics B Department, Hillel Yaffe Medical Center, Hadera, Israel
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26
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Khan AA, AbuAlrob H, Al-Alwani H, Ali DS, Almonaei K, Alsarraf F, Bogoch E, Dandurand K, Gazendam A, Juby AG, Mansoor W, Marr S, Morgante E, Myslik F, Schemitsch E, Schneider P, Thain J, Papaioannou A, Zalzal P. Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators. Osteoporos Int 2023; 34:1011-1035. [PMID: 37014390 DOI: 10.1007/s00198-022-06640-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada.
| | - Hajar AbuAlrob
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Hatim Al-Alwani
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Khulod Almonaei
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Farah Alsarraf
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Earl Bogoch
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Karel Dandurand
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Angela G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wasim Mansoor
- Trillium Health Partners, University of Toronto, Toronto, ON, Canada
| | - Sharon Marr
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmett Morgante
- Bone Research and Education Center Patient Support Program and Education Coordinator, Oakville, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Emil Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Prism Schneider
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Zalzal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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27
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Scheffers-Barnhoorn MN, Haaksma ML, Achterberg WP, Niggebrugge AH, van der Sijp MP, van Haastregt JC, van Eijk M. Course of fear of falling after hip fracture: findings from a 12-month inception cohort. BMJ Open 2023; 13:e068625. [PMID: 36918243 PMCID: PMC10016251 DOI: 10.1136/bmjopen-2022-068625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES To examine the course of fear of falling (FoF) up to 1 year after hip fracture, including the effect of prefracture FoF on the course. DESIGN Observational cohort study with assessment of FoF at 6, 12 and 52 weeks after hip fracture. SETTING Haaglanden Medical Centre, the Netherlands. PARTICIPANTS 444 community-dwelling adults aged 70 years and older, admitted to hospital with a hip fracture. MAIN OUTCOME MEASURE Short Falls Efficacy Scale International (FES-I), with a cut-off score ≥11 to define elevated FoF levels. RESULTS Six weeks after hip fracture the study population-based mean FES-I was located around the cut-off value of 11, and levels decreased only marginally over time. One year after fracture almost one-third of the population had FoF (FES-I ≥11). Although the group with prefracture FoF (42.6%) had slightly elevated FES-I levels during the entire follow-up, the effect was not statistically significant. Patients with persistent FoF at 6 and 12 weeks after fracture (26.8%) had the highest FES-I levels, with a mean well above the cut-off value during the entire follow-up. For the majority of patients in this group, FoF is still present 1 year after fracture (84.9%). CONCLUSIONS In this study population, representing patients in relative good health condition that are able to attend the outpatient follow-up at 6 and 12 weeks, FoF as defined by an FES-I score ≥11 was common within the first year after hip fracture. Patients with persistent FoF at 12 weeks have the highest FES-I levels in the first year after fracture, and for most of these patients the FoF remains. For timely identification of patients who may benefit from intervention, we recommend structural assessment of FoF in the first 12 weeks after fracture.
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Affiliation(s)
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
| | | | - Max Pl van der Sijp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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28
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Fusco A. Is multidisciplinary rehabilitation effective for individuals with hip fractures? - A Cochrane Review summary with commentary. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2023; 23:1-3. [PMID: 36856095 PMCID: PMC9976177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Augusto Fusco
- High-Intensity Neurorehabilitation; Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences; Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy
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29
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Lubbe AL, van Rijn M, Groen WG, Hilhorst S, Burchell GL, Hertogh CMPM, Pol MC. The quality of geriatric rehabilitation from the patients' perspective: a scoping review. Age Ageing 2023; 52:7078338. [PMID: 36928115 PMCID: PMC10020894 DOI: 10.1093/ageing/afad032] [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: 10/11/2022] [Revised: 12/22/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND the efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist. OBJECTIVE the aim of this scoping review was to systematically synthesise the patients' perspective on the quality of GR. METHODS we followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach. RESULTS twenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one's story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home. CONCLUSION in this study, we identified the aspects that determine the quality of rehabilitation from the patient's perspective, which may lead to a more holistic perspective on the quality of GR.
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Affiliation(s)
- Anne L Lubbe
- Address correspondence to: Anne L. Lubbe, MSc, Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands. Tel: (+31)651511451.
| | - Marjon van Rijn
- Departement of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
| | - Wim G Groen
- Departement of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | | | - George L Burchell
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Departement of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Margriet C Pol
- Departement of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
- Research Group Occupational Therapy: Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
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30
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Roberts N, Carrigan A, Clay-Williams R, Hibbert PD, Mahmoud Z, Pomare C, Fajardo Pulido D, Meulenbroeks I, Knaggs GT, Austin EE, Churruca K, Ellis LA, Long JC, Hutchinson K, Best S, Nic Giolla Easpaig B, Sarkies MN, Francis Auton E, Hatem S, Dammery G, Nguyen MT, Nguyen HM, Arnolda G, Rapport F, Zurynski Y, Maka K, Braithwaite J. Innovative models of healthcare delivery: an umbrella review of reviews. BMJ Open 2023; 13:e066270. [PMID: 36822811 PMCID: PMC9950590 DOI: 10.1136/bmjopen-2022-066270] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. DESIGN Umbrella review. SETTING Interventions delivered inside and outside of acute care settings. PARTICIPANTS Children and adults with one or more identified acute or chronic health conditions. DATA SOURCES PsycINFO, Ovid MEDLINE and CINAHL. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. RESULTS A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. CONCLUSIONS A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/PS6ZU.
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Affiliation(s)
- Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- LEMNA, F-44000, Universite de Nantes, Nantes, France
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mai-Tran Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Geriatric rehabilitation care after hip fracture. Eur Geriatr Med 2023; 14:295-305. [PMID: 36788193 PMCID: PMC10113343 DOI: 10.1007/s41999-023-00755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE After acute hospital admission, patients with a hip fracture are frequently discharged to skilled nursing homes providing geriatric rehabilitation (GR). There are few evidence-based studies regarding specific treatment times and assessments during GR. This study aims to provide a description of care for hip fracture patients during GR in the Netherlands. METHODS Descriptive study analyzing the care pathways from GR facilities, regarding healthcare professionals involved, allocated treatment time per profession, total length of rehabilitation stay, and assessment instruments. Based on the reimbursement algorithm (diagnostic treatment combination = DBCs), of 25 patients, the registered actual treatment time per profession was calculated. RESULTS The care pathways pivoted on three groups of health care professionals: medical team (MT), physiotherapy (PT), and occupational therapy (OT). There was some discrepancy between the allocated time in the care pathways and the calculated mean actual treatment time from the DBCs. First week: MT 120-180 min, DBC 120 (SD: 59) minutes; PT 120-230 min, DBC 129 (SD: 58) minutes; and OT 65-165 min, DBC 93 (SD: 61) minutes. From week two onwards, MT 15-36 min, DBC 49 (SD: 29) minutes; PT 74-179 min, DBC 125 (SD: 50) minutes; and OT 25-60 min, DBC 47 (SD: 44) minutes. Dieticians, psychologists, and social workers were sporadically mentioned. There was heterogeneity in the assessment and screening tools. CONCLUSIONS It is difficult to define current standard care in GR after hip fracture in the Netherlands due to the diversity in care pathways and large practice variation. This is a problem in conducting randomized effectiveness research with care provided as control. TRIAL REGISTER AND DATE OF REGISTRATION NL7491 04-02-2019.
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Ravensbergen WM, Timmer IL, Gussekloo J, Blom JW, van Eijk M, Achterberg WP, Evers AWM, van Dijk S, Drewes YM. Self-perceived functioning and (instrumental) activities of daily living questionnaires after a hip fracture: Do they tell the same story? Age Ageing 2022; 51:6834148. [PMID: 36434800 PMCID: PMC9701104 DOI: 10.1093/ageing/afac259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND (Instrumental) activities of daily living ((I)ADL) questionnaires are often used as a measure of functioning for different purposes. Depending on the purpose, a measurement of functioning that includes subjective patient perspectives can be relevant. However, it is unclear to what extent (I)ADL instruments capture self-perceived functioning. OBJECTIVE Explore what functioning means to older persons after a hip fracture and assess the extent to which (I)ADL instruments align with self-perceived functioning. DESIGN Qualitative interview study with framework analysis. SETTING Prospective cohort study on recovery after a hip fracture among older persons in a hospital in a large city in the west of the Netherlands. SUBJECTS Eighteen home-dwelling older persons (≥70 years) who had a hip fracture 6-12 months ago. METHODS Telephone interviews about functioning before and after the hip fracture were coded and analysed using the framework method. RESULTS The activities mentioned by participants to be part of their self-perceived functioning could be split into activities necessary to maintain the desired level of independence, and more personal activities that were of value to participants. Both the 'independence activities' and the 'valued activities' mentioned went beyond the activities included in (I)ADL questionnaires. Due to various coping strategies, limitations in activities that are measured in the (I)ADL questionnaires did not necessarily lead to worse self-perceived functioning. CONCLUSION Self-perceived functioning differs from functioning measured with (I)ADL questionnaires in the items included and the weighing of limitations in activities. Thus, (I)ADL instruments alone are not enough to measure functioning from the perspective of the older person.
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Affiliation(s)
| | - Irie L Timmer
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Monica van Eijk
- 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
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Yvonne M Drewes
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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Mohamed Elfadil O, Keaveney E, Patel A, Abdelmagid MG, Patel I, Patel J, Hurt RT, Mundi MS. Usability of a Novel Enteral Feeding System: A Summative Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:253-262. [PMID: 35958115 PMCID: PMC9362904 DOI: 10.2147/mder.s367100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Utilization of long-term home enteral nutrition (HEN) for nutrition therapy is increasing across the world. However, HEN can be a mobility-limiting experience affecting quality of life (QoL). Improvement of QoL for patients receiving HEN is a universal goal within the nutrition community. This study evaluated usability of Mobility+®, a novel enteral feeding system (EFS). Methods A summative study evaluating usability of the novel EFS was conducted with novices (NV), non-novices (NN), and healthcare professionals (HCP). Subjects in NV and NN groups received familiarization training where they were introduced to the novel EFS and walked through steps to fill pouch, simulate feeding, flush (rinse), and wear the system, using the Instructions for Use (IFU) booklet, followed by a testing session where they simulated system use on their own. HCP self-trained using the IFU and instructional videos. A fill from ready-to-hang (RTH) formula bag method was also tested in HCP. Participants’ ability to loosely coil the tubing and sit, stand, and move around wearing a filled feeding pouch inside a crossbody bag was also evaluated. Results Forty-five participants completed the study. All participants successfully and safely simulated use of the novel EFS, with 97.8% (44/45) doing so on first attempt. All participants could wear the novel EFS in crossbody bag and move around without any use errors or safety issues. Conclusion The examined novel EFS can be safely used in intended use population, with or without previous experience with enteral nutrition, on provision of basic familiarization training and written IFU. Additionally, HCP can successfully self-train on this system with instructional videos. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/WWR06dCUPts
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Affiliation(s)
- Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Ankitaben Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Marwa G Abdelmagid
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ishani Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Jalpan Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Correspondence: Manpreet S Mundi, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, Tel +1 507-284-0106, Fax +1 507-284-5745, Email
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Karlsson Å, Olofsson B, Stenvall M, Lindelöf N. Older adults' perspectives on rehabilitation and recovery one year after a hip fracture - a qualitative study. BMC Geriatr 2022; 22:423. [PMID: 35562681 PMCID: PMC9107124 DOI: 10.1186/s12877-022-03119-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background In order to improve quality of care and recovery after hip fracture we need to include the perspectives of the individual older adults when evaluating different rehabilitation interventions. The aim of this study was therefore to explore older adults’ experiences of their rehabilitation after a hip fracture and of the recovery process during the 12 months following the fracture. Methods Qualitative interviews were conducted with 20 older adults (70–91 years of age) who had participated in a randomised controlled trial evaluating the effects of early discharge followed by geriatric interdisciplinary home rehabilitation compared to in-hospital care according to a multifactorial rehabilitation program. Ten participants from each group were interviewed shortly after the one-year follow-up when the study was completed. Data were analysed with qualitative content analysis. Results The analysis resulted in four themes: Moving towards recovery with the help of others; Getting to know a new me; Striving for independence despite obstacles; and Adapting to an altered but acceptable life. The participants emphasised the importance of having access to rehabilitation that was provided by skilled staff, and support from family members and friends for well-being and recovery. They experienced a change in their self-image but strove for independence despite struggling with complications and functional limitations and used adaptive strategies to find contentment in their lives. Conclusions Rehabilitation interventions provided by competent health care professionals, as well as support from family members and friends, were emphasised as crucial for satisfactory recovery. Participants’ experiences further highlight the importance of targeting both physical and psychological impacts after a hip fracture. To improve recovery, rehabilitation providers should customise future interventions to suit each individual´s wishes and needs and provide rehabilitation in various settings throughout the recovery process. Trial registration The trial is registered at Current Controlled Trials Ltd, ICRCTN 15738119. Date of registration 16/06/2008, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03119-y.
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Affiliation(s)
- Åsa Karlsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 90187, Umeå, Sweden. .,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden.
| | - Birgitta Olofsson
- Department of Nursing and Department of Surgical and Perioperative Science, Orthopedics, Umeå University, 90187, Umeå, Sweden
| | - Michael Stenvall
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
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Ma Y, Wang A, Lou Y, Peng D, Jiang Z, Xia T. Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:829762. [PMID: 35402430 PMCID: PMC8984086 DOI: 10.3389/fmed.2022.829762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
Background Frailty is a syndrome of multisystem dysfunction in the elderly. The association between preoperative frailty and postoperative outcomes in patients with hip fractures is unclear. To address this issue, we performed a meta-analysis to determine the association of frailty with postoperative mortality, complications, and readmission in patients with hip fractures. Methods We searched PubMed, Web of Science, Embase, and The Cochrane Library for cohort studies of frailty associated with postoperative adverse events in patients with hip fractures from inception to November 6, 2021. The Newcastle-Ottawa Scale was used to evaluate the quality of the included literature. Statistical analysis of meta-analysis was performed using Review Manager 5.3. Results Twelve retrospective cohort studies and seven prospective cohort studies involving a total of 62,132 patients met the inclusion criteria for this meta-analysis. Compared with non-frail patients, the pooled results showed that frailty was associated with patient in-hospital mortality (relative risk [RR] = 2.93; 95% confidence intervals [CI]: 2.56–3.34), 30-day mortality (RR = 2.85, 95%CI: 1.67–4.85) and total complications (RR = 1.79, 95%CI: 1.50–2.15). Subgroup analysis showed that the type of study design and frailty assessment tool had no significant effect on the results. Sensitivity analysis showed that the polled results of frailty predicted one-year mortality and 30-day readmission was unstable. Conclusions In this meta-analysis, we found that preoperative frailty may be associated with postoperative adverse events in patients with hip fractures, including in-hospital mortality, 30-day mortality, and postoperative complications. Systematic Review Registration: PROSPERO, identifier: CRD42021287739.
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Affiliation(s)
- Yan Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Ansu Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yijiao Lou
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Daojuan Peng
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Zhongyan Jiang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tongxia Xia
- Nursing School, Zunyi Medical University, Zunyi, China
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- *Correspondence: Tongxia Xia
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