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Arcolin I, Giardini M, Corna S, Sartorio F, Caligari M, Godi M. Construct validity, responsiveness and minimal important difference of the cumulated ambulation score in older adults with hip fracture in sub-acute rehabilitation facility. Clin Rehabil 2024:2692155241249351. [PMID: 38656174 DOI: 10.1177/02692155241249351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To assess the construct validity, responsiveness and minimal important difference of the cumulated ambulation score in patients with hip fracture in sub-acute rehabilitation facility. DESIGN Observational, prospective, monocenter, cohort study. SETTING Rehabilitation Institute. PARTICIPANTS 456 older adults with hip fracture (≥65 years) admitted for inpatient rehabilitation. MAIN OUTCOME MEASURES Cumulated ambulation score, functional independence measure and functional ambulation category were collected at admission and discharge. Construct validity and responsiveness were assessed through hypothesis testing and minimal important difference was determined using the anchor-based method; floor and ceiling effects were also assessed. RESULTS The cumulated ambulation score showed strong correlations with the functional independence measure and functional ambulation category scores at both admission and discharge, satisfying all the hypotheses for construct validity. The effect size of cumulated ambulation score was 1.63. Changes in cumulated ambulation score had a moderate-to-strong correlation with changes of other instruments and were able to discriminate patients improved from those not-improved, and patients classified as independent ambulators from those dependent. A ceiling effect was found only at discharge. The estimated minimal important difference was 2 points. CONCLUSIONS The cumulated ambulation score showed high levels of construct validity and responsiveness according to the hypothesis testing. A two points improvement at the end of rehabilitation was found to be clinically important in people with hip fracture in the sub-acute phase. The ceiling effect found at discharge suggested the limitation of the scale in assessing people with a partially recovered autonomy in performing postural changes and gait.
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Affiliation(s)
- Ilaria Arcolin
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Marica Giardini
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Stefano Corna
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
| | - Francesco Sartorio
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
- Department of Scientific Research Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Budapest, Hungary
| | - Marco Caligari
- Integrated Laboratory of Assistive Solutions and Translational Research (LISART), Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Pavia, Italy
| | - Marco Godi
- Department of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, Gattico-Veruno, Italy
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Savio SD, Kawiyana IKS, Wiratnaya IGE, Sumadi IWJ, Suyasa IK. Low Hand Grip Strength, Mid-Upper Arm Muscle Area, Calf Circumference, Serum Albumin Level, and Muscle Fiber Diameter as Risk Factors for Independent Walking Inability in Patients with Hip Fracture 6 Weeks after Bipolar Hemiarthroplasty Surgery. Clin Orthop Surg 2024; 16:230-241. [PMID: 38562634 PMCID: PMC10973617 DOI: 10.4055/cios23256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 04/04/2024] Open
Abstract
Background Bipolar hemiarthroplasty, one of the main treatment modalities for hip fracture, does not always promise the ability to walk independently after surgery. Patients with the same fracture characteristics and comorbidities, implants, and operators may also have different outcomes. Sarcopenia is thought to be one of the causes of the inability to walk independently after this operation; however, it has not been widely studied and is often overlooked. Methods This study used a case-control design with 23 patients in the case group (patients unable to walk independently) and 23 patients in the control group (patients able to walk independently). Sampling was carried out consecutively according to the inclusion and exclusion criteria based on the medical records of patients with hip fractures after bipolar hemiarthroplasty at our hospital. In the preoperative period, hand grip strength (HGS), mid-upper arm muscle area (MUAMA), calf circumference (CC), serum albumin level, and total lymphocyte count were measured. A muscle biopsy was performed intraoperatively from the gluteus muscle with the amount of 200-350 mg. The patient's walking ability was assessed in the polyclinic using the Timed Up and Go test 6 weeks postoperatively. The statistical tests used were descriptive statistics, proportion comparison analysis with the chi-square test, and multiple logistic regression test. Results Univariate analysis using chi-square test proved HGS, MUAMA, CC, serum albumin level, and muscle fiber diameter as risk factors for inability to walk independently 6 weeks after bipolar hemiarthroplasty (p = 0.003, p = 0.003, p = 0.006, p = 0.044, and p = 0.000, respectively). Logistic regression test proved 3 direct risk factors for the inability to walk independently 6 weeks after bipolar hemiarthroplasty, namely MUAMA, serum albumin level, and muscle fiber diameter, as the strongest predictive factor (adjusted odds ratio, 63.12). Conclusions Low MUAMA, serum albumin levels, and muscle fiber diameter are direct risk factors for the inability to walk independently in hip fracture patients 6 weeks after bipolar hemiarthroplasty.
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Affiliation(s)
- Sherly Desnita Savio
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Ketut Siki Kawiyana
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Gede Eka Wiratnaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Wayan Juli Sumadi
- Department of Anatomical Pathology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Ketut Suyasa
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
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Koudouna S, Evangelopoulos DS, Sarantis M, Chronopoulos E, Dontas IA, Pneumaticos S. Rehabilitation Prognostic Factors following Hip Fractures Associated with Patient's Pre-Fracture Mobility and Functional Ability: A Prospective Observation Study. Life (Basel) 2023; 13:1748. [PMID: 37629604 PMCID: PMC10455283 DOI: 10.3390/life13081748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool.
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Affiliation(s)
- Smaragda Koudouna
- 3rd Department of Orthopaedic Surgery, KAT Hospital, 145 61 Athens, Greece; (S.K.); (D.S.E.); (S.P.)
- Department of Physiotherapy, KAT Hospital, 145 61 Athens, Greece
| | | | - Michail Sarantis
- 4th Department of Orthopaedic Surgery, KAT Hospital, 145 61 Athens, Greece
| | - Efstathios Chronopoulos
- Laboratory for Research of the Musculoskeletal System, National and Kapodistrian University, KAT Hospital, 145 61 Athens, Greece; (E.C.); (I.A.D.)
| | - Ismene A. Dontas
- Laboratory for Research of the Musculoskeletal System, National and Kapodistrian University, KAT Hospital, 145 61 Athens, Greece; (E.C.); (I.A.D.)
| | - Spiridon Pneumaticos
- 3rd Department of Orthopaedic Surgery, KAT Hospital, 145 61 Athens, Greece; (S.K.); (D.S.E.); (S.P.)
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Koudouna S, Evangelopoulos DS, Sarantis M, Chronopoulos E, Dontas IA, Pneumaticos S. The Effect of Postoperative Physical Therapy Following Hip Fracture: A Literature Review. Cureus 2023; 15:e37676. [PMID: 37206486 PMCID: PMC10189836 DOI: 10.7759/cureus.37676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
Hip fractures in the elderly have become a major public health concern as the population ages. Post-operative rehabilitation is associated with improved outcomes and a greater likelihood of returning to pre-operative functional capacity. Several studies have been conducted to investigate various post-operative recovery pathways. However, little is known about which post-operative rehabilitation pathways for hip fractures are most effective in improving patient outcomes. No clear evidence-based guidelines for a standard mobilization protocol for patients are currently available. This review aims to investigate post-operative recovery pathways to help patients suffering from hip fracture return to pre-fracture condition and to quantify pre-operative and post-operative scores for objective rehabilitation evaluation. Measuring pre-operative activity and comparing it to post-operative follow-up values can help predict post-operative rehabilitation functional outcomes.
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Affiliation(s)
- Smaragda Koudouna
- Department of Physiotherapy, General Hospital of Attika 'KAT', Athens, GRC
| | - Dimitrios S Evangelopoulos
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
| | - Michail Sarantis
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
| | - Efstathios Chronopoulos
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
- Department of Orthopedic Surgery, Laboratory for Research of the Musculoskeletal System (LRMS) of the School of Medicine, University of Athens, Athens, GRC
| | - Ismene A Dontas
- Department of Veterinary Medicine, Laboratory for Research of the Musculoskeletal System (LRMS) of the School of Medicine, University of Athens, Athens, GRC
- Department of Veterinary Medicine, General Hospital of Attika 'KAT', Athens, GRC
- Department of Veterinary Medicine, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
| | - Spiros Pneumaticos
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
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Rix A, Lawrence D, Raper E, Calthorpe S, Holland AE, Kimmel LA. Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties. Phys Ther 2022; 103:pzac142. [PMID: 36222144 DOI: 10.1093/ptj/pzac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/09/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. METHODS Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. RESULTS Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. CONCLUSION Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. IMPACT This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.
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Affiliation(s)
- Alana Rix
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Drew Lawrence
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Eleanor Raper
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sadala AY, Rampazo ÉP, Liebano RE. Vibration anesthesia during carboxytherapy for cellulite: a study protocol. Pain Manag 2022; 12:401-408. [PMID: 35001651 DOI: 10.2217/pmt-2021-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: To date, there has been no investigation addressing the effects of vibration anesthesia during carboxytherapy. Aim: Investigate the analgesic effect of different vibratory devices during carboxytherapy for the treatment of cellulite. Materials & methods: A total of 78 women between 18 and 49 years of age with cellulite in the gluteal region will be randomly allocated to three groups: Group A (carboxytherapy and vibratory device A), Group B (carboxytherapy and vibratory device B) and control group. Pain intensity will be assessed using a numerical rating scale after each puncture. Expected outcome: Vibration anesthesia is expected to be effective at diminishing the pain intensity caused by carboxytherapy comparison with the control group, with no differences between the vibratory devices. Trial registry: Brazilian Registry of Clinical Trials- ReBEC (RBR-8jcqy7c).
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Affiliation(s)
- Adria Yared Sadala
- Department of Physical Therapy, Post-Graduation Program in Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP, Brazil
| | - Érika Patrícia Rampazo
- Department of Physical Therapy, Post-Graduation Program in Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP, Brazil
| | - Richard Eloin Liebano
- Department of Physical Therapy, Post-Graduation Program in Physical Therapy, Federal University of São Carlos (UFSCar), Rod. Washington Luis, km 235, São Carlos/SP, Brazil
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Arcolin I, Godi M, Giardini M, Guglielmetti S, Corna S. Does the type of hip fracture affect functional recovery in elderly patients undergoing inpatient rehabilitation? Injury 2021; 52:2373-2378. [PMID: 33879338 DOI: 10.1016/j.injury.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF). METHODS A retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline. RESULTS Age (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced. CONCLUSIONS The type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.
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Affiliation(s)
- Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Marica Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Simone Guglielmetti
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
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Hulsbæk S, Bandholm T, Ban I, Foss NB, Jensen JEB, Kehlet H, Kristensen MT. Feasibility and preliminary effect of anabolic steroids in addition to strength training and nutritional supplement in rehabilitation of patients with hip fracture: a randomized controlled pilot trial (HIP-SAP1 trial). BMC Geriatr 2021; 21:323. [PMID: 34016037 PMCID: PMC8136760 DOI: 10.1186/s12877-021-02273-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Anabolic steroid has been suggested as a supplement during hip fracture rehabilitation and a Cochrane Review recommended further trials. The aim was to determine feasibility and preliminary effect of a 12-week intervention consisting of anabolic steroid in addition to physiotherapy and nutritional supplement on knee-extension strength and function after hip fracture surgery. Methods Patients were randomized (1:1) during acute care to: 1. Anabolic steroid (Nandrolone Decanoate) or 2. Placebo (Saline). Both groups received identical physiotherapy (with strength training) and a nutritional supplement. Primary outcome was change in maximal isometric knee-extension strength from the week after surgery to 14weeks. Secondary outcomes were physical performance, patient reported outcomes and body composition. Results Seven hundred seventeen patients were screened, and 23 randomised (mean age 73.4years, 78% women). Target sample size was 48. Main limitations for inclusion were not home-dwelling (18%) and cognitive dysfunction (16%). Among eligible patients, the main reason for declining participation was Overwhelmed and stressed by situation (37%). Adherence to interventions was: Anabolic steroid 87%, exercise 91% and nutrition 61%. Addition of anabolic steroid showed a non-significant between-group difference in knee-extension strength in the fractured leg of 0.11 (95%CI -0.25;0.48) Nm/kg in favor of the anabolic group. Correspondingly, a non-significant between-group difference of 0.16 (95%CI -0.05;0.36) Nm/Kg was seen for the non-fractured leg. No significant between-group differences were identified for the secondary outcomes. Eighteen adverse reactions were identified (anabolic=10, control=8). Conclusions Early inclusion after hip fracture surgery to this trial seemed non-feasible, primarily due to slow recruitment. Although inconclusive, positive tendencies were seen for the addition of anabolic steroid. Trial registration Clinicaltrials.gov NCT03545347. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02273-z.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ilija Ban
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bang Foss
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jens-Erik Beck Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology 7621, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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10
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Lee KJ, Um SH, Kim YH. Postoperative Rehabilitation after Hip Fracture: A Literature Review. Hip Pelvis 2020; 32:125-131. [PMID: 32953704 PMCID: PMC7476786 DOI: 10.5371/hp.2020.32.3.125] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 01/15/2023] Open
Abstract
As the proportion of elderly individuals within the population grows, the incidence of hip fractures increases. Traditionally, orthopedic surgeons used to focus on surgical treatment of hip fractures; however, the field's appreciation for the importance of postoperative rehabilitation has been increasing recently. Many studies have shown that proper rehabilitation after hip fracture surgery can shorten hospital stays and improve clinical outcomes. However, such studies use different methods and published rehabilitation protocols address varying aspects that do not always overlap. Here, we review and summarize the latest guidelines and studies on postoperative rehabilitation of elderly patients with hip fractures.
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Affiliation(s)
- Kyung-Jae Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Hyun Um
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Hun Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Galhardas L, Raimundo A, Marmeleira J. Test-retest reliability of upper-limb proprioception and balance tests in older nursing home residents. Arch Gerontol Geriatr 2020; 89:104079. [DOI: 10.1016/j.archger.2020.104079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022]
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Kristensen MT. Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1841. [PMID: 32363803 DOI: 10.1002/pri.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the influence and risk of falls of individual factors on timed up and go test (TUG) times using standardized instructions in patients with hip fracture upon discharge from an acute orthopaedic hip fracture unit. METHODS Following instructions, the TUG was performed three times with a rollator (standardized aid), as fast as safely possible. Up to a 1-min rest was given after the first and second TUG trial. Multivariable linear regression analysis was used to investigate the factors influencing TUG-times and corresponding logistic analysis was used to investigate factors indicating risk of falls, using a cut-off of 24 s for TUG. RESULTS A total of 181 patients (122 women), 60 years or older, with a mean (SD) age of 78.1 (9.1) years were studied. The fastest of three TUG trials performed within a mean of 10.0 (5.2) post-surgery days and used in analyses reached a mean of 25.6 (11.0) s. Multivariable regression analysis showed that greater age (B = 0.24; 2.4s more per decade older), a low pre-fracture function level (New Mobility Score <7 points, B = 6.4s more than high level), having a trochanteric fracture (B = 6.2 s, vs. cervical), and the post-surgery day of testing (B = 0.42, 4.2s per 10 days later) were independently associated with using more time for performing the TUG. Correspondingly, the same four factors indicated an increased risk of falls in the logistic analysis. The linear model explained 28% of the variance on TUG, while the accuracy of the logistic model to predict patients having TUG≥24 s was 69%. CONCLUSION The age, pre-fracture function, fracture type and post-surgery day of TUG testing were identified as strong factors influencing TUG performances and TUG-times indicating risk of falls in patients with hip fracture. We suggest that these factors be considered when interpreting TUG test results and in further rehabilitation and fall prevention efforts.
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Affiliation(s)
- Morten T Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Hatch J, Veneri D. The effect of rolling walker use on interpretation of Timed Up and Go test scores: a preliminary study. Int J Rehabil Res 2019; 43:95-98. [PMID: 31764216 DOI: 10.1097/mrr.0000000000000388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies have shown that the type of assistive device used during the Timed Up and Go test impacts the time it takes to complete the test. This study examines the impact of the use of a rolling walker within individuals on Timed Up and Go scores and assessment of fall risk. The Berg Balance Scale, Timed Up and Go, and linear gait speed were used to measure balance and fall risk on 13 older adults as part of their usual reassessment in preparation for discharge. Timed Up and Go and gait speed scores were compared assistive device conditions. The Berg Balance Scale was used as a benchmark fall risk assessment. Linear gait speed was similar in both conditions. Timed Up and Go times were slower for all patients using a rolling walker versus a cane or no assistive device. Consideration for the effect of assistive device use on Timed Up and Go scores has important implications as it may influence interpretation of fall risk.
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Affiliation(s)
- Janine Hatch
- Department of Physical Therapy, Sacred Heart University, Fairfield, Connecticut, USA
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Mobility after intertrochanteric hip fracture fixation with either a sliding hip screw or a cephalomedullary nail: Sub group analysis of a randomised trial of 1000 patients. Injury 2019; 50:1709-1714. [PMID: 31256911 DOI: 10.1016/j.injury.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
AIMS The aim of this study was to determine if different patient groups have superior mobility regain following intertrochanteric hip fracture fixation with a cephomedullary nail compared to a sliding hip screw (SHS). PATIENTS AND METHODS The present study is a subgroup analysis of patients which were enrolled into a randomized controlled trial which randomized 1000 patients with an intertrochanteric hip fracture to fixation with either a short cephomedullary nail (Targon® PF or PFT) or a SHS. In the present study the two treatment groups were dicotomised on the basis of six variables determined at the time of admission; age (<80; ≥80 years), sex, residence (admitted from own home; institutional care), mobility (mobility score ≥7 [good]; <7 [poor]), mental status (AMTS < 7 [cognitively impaired]; ≥7) and health status (ASA < 3; ≥3). The primary outcome measure was the difference between mobility score pre-fracture and mobility score during the year after hip fracture fixation. RESULTS Patients less than 80 years of age, those admitted from their own home, cognitively intact patients and patients who mobilised without assistance pre-fracture, recovered superior mobility when fracture fixation was performed with a nail compared to a SHS. Those patients admitted from institutional care, those with significant cognitive or mobility impairment at the time of the injury did not have any significantly improved benefit in mobility regain with a nail compared to a SHS. CONCLUSION Fixation of an intertrochanteric hip fracture with a cephomedullary nail results in superior recovery of mobility for younger patients who prior to the injury were more mobile, cognitively intact and living at home.
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Ibrahim N'I, Sharkawi Ahmad M, Zulfarina MS, Zaris SNASM, Nor Azlin ZA, Naina Mohamed I, Mohamed N, Mokhtar SA, Shuid AN. Physical function assessment of older adults with lower body fractures at 3 months post-discharge from hospital. Ther Clin Risk Manag 2019; 15:201-210. [PMID: 30774356 PMCID: PMC6357875 DOI: 10.2147/tcrm.s189748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and purpose Physical function assessment can be performed to assess functional mobility among older adults, especially after a traumatic incident such as lower body fracture (LBF). The objective of this study was to evaluate physical function of older patients with LBF after 3 months of discharge from the hospital. Patients and methods A total of 89 patients were followed up at the discharge phase. Four independent variables were tested: age, sex, type of fracture, and use of a walking aid before fracture. Mobility and strength were assessed with the Timed Up and Go (TUG) test and hand-grip strength (HGS) test, respectively. Results The majority of the patients were ≥65 years old (64%), female (61.8%), of Chinese ethnicity (50.6%), and had a hip fracture (51.7%). The mean time for TUG test was 26.11 seconds, while mean HGS was 19.02 kg. We found significant differences in TUG test scores with respect to all independent variables tested: age (P=0.026), sex (P=0.011), fracture type (P<0.001), and use of a walking aid before fracture (P=0.004). Significant differences were also detected in HGS test scores with respect to all independent variables tested: age (P<0.001), sex (P<0.001), fracture type (P<0.001), and use of a walking aid before fracture (P=0.035). Conclusion Increasing age, female sex, having a hip fracture, and use of a walking aid before fracture predicted reduction in the physical function and strength among older adults with LBF.
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Affiliation(s)
- Nurul 'Izzah Ibrahim
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Mohd Sharkawi Ahmad
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Mohamed S Zulfarina
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | | | | | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Norazlina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Sabarul Afian Mokhtar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
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16
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Kristensen MT, Bloch ML, Jønsson LR, Jakobsen TL. Interrater reliability of the standardized Timed Up and Go Test when used in hospitalized and community‐dwelling older individuals. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1769. [DOI: 10.1002/pri.1769] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/07/2018] [Accepted: 12/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR‐C), Department of Physical and Occupational TherapyCopenhagen University Hospital Amager‐Hvidovre Hvidovre Denmark
- Department of Orthopedic SurgeryCopenhagen University Hospital Amager‐Hvidovre Hvidovre Denmark
| | - Mette Linding Bloch
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and TechnologyUniversity College Copenhagen Copenhagen Denmark
- The Specialized Hospital for Polio and Accident Victims Rødovre Denmark
| | - Line Rokkedal Jønsson
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR‐C), Department of Physical and Occupational TherapyCopenhagen University Hospital Amager‐Hvidovre Hvidovre Denmark
| | - Thomas Linding Jakobsen
- Section for Orthopaedic and Sports Rehabilitation (SOS‐R)Health Center Nørrebro Copenhagen Denmark
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17
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Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C. Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing 2018; 47:661-670. [PMID: 29668839 DOI: 10.1093/ageing/afy057] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective this systematic review aimed to identify immutable and modifiable prognostic factors of functional outcomes and their proposed mechanism after hip fracture surgery. Design systematic search of MEDLINE, Embase, CINAHL, PEDRO, OpenGrey and ClinicalTrials.gov for observational studies of prognostic factors of functional outcome after hip fracture among surgically treated adults with mean age of 65 years and older. Study selection, quality assessment, and data extraction were completed independently by two reviewers. The Quality in Prognosis Studies Tool was used for quality assessment and assigning a level of evidence to factors. Proposed mechanisms for reported associations were extracted from discussion sections. Results from 33 studies of 9,552 patients, we identified 25 prognostic factors of functional outcome after hip fracture surgery. We organised factors into groups: demographics, injury and comorbidities, body composition, complications, and acute care. We assigned two factors a weak evidence level-anaemia and cognition. We assigned Parkinson's disease an inconclusive evidence level. We could not assign an evidence level to the remaining 22 factors due to the high risk of bias across studies. Frailty was the proposed mechanism for the association between anaemia and functional outcome. Medication management, perceived potential, complications and time to mobility were proposed as mechanisms for the association between cognition and functional outcome. Conclusion we identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - L Williamson
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - J Alexander
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Filliter
- Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - L M Bearne
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
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18
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Perracini MR, Kristensen MT, Cunningham C, Sherrington C. Physiotherapy following fragility fractures. Injury 2018; 49:1413-1417. [PMID: 29958686 DOI: 10.1016/j.injury.2018.06.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
Physiotherapy can play a vital role in the pathway of care of people after fragility fracture and includes interventions of early mobilisation and prescription of structured exercise programmes for maximising functional recovery and reducing the risk of falls and further fractures. Although the optimal nature of physiotherapist interventions after hip and vertebral fracture requires further investigation in large-scale trials, evidence supports the prescription of high-intensity and extended exercise interventions. This article will overview interventions in the acute and chronic phases after hip fractures, interventions after vertebral fracture and the role of physiotherapy in the prevention of further fractures.
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Affiliation(s)
- Monica R Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil.
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physical Therapy, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Denmark
| | - Caitriona Cunningham
- Assistant Professor, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Cathie Sherrington
- Ageing and Physical Disability Program, Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Australia
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19
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Characteristics and Outcomes of Patients in Rehabilitation with Hip Fracture: A Retrospective Chart Review. Can J Aging 2018; 37:270-280. [PMID: 29983127 DOI: 10.1017/s0714980818000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTHip fracture rehabilitation has two streams: high tolerance short duration (HTSD) and low tolerance long duration (LTLD). This study examined patient characteristics and outcomes in HTSD and LTLD associated with length of stay (LOS) and discharge destination. We retrospectively examined patients' medical charts following hip fracture surgery and collected demographic, functional, and health characteristics. A statistical analysis was done to describe the differences between HTSD (n = 73) and LTLD (n = 57) patient characteristics and their relationship with LOS and discharge destination. Those in LTLD were significantly older, less independent with prefracture bathing and instrumental activities of daily living, had lower Functional Independence Measure (FIM) admission scores, and more co-morbidities. Higher FIM motor score on admission in HTSD and greater change in FIM total score in LTLD was significantly correlated with discharge home. Diabetes in LTLD and lower total admission FIM in HTSD was significantly associated with increased LOS.
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20
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Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, Mawdesley K, Hawkes CA, Morrison V, Lemmey A, Edwards RT, Hoare Z, Pritchard AW, Woods RT, Alexander S, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technol Assess 2018; 21:1-528. [PMID: 28836493 DOI: 10.3310/hta21440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Proximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking. OBJECTIVES To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation. DESIGN Phase I - realist review, survey and focus groups to develop the rehabilitation package. Phase II - parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study. SETTING Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge. PARTICIPANTS Older adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area. INTERVENTIONS Participants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients' self-efficacy and increasing the amount and quality of patients' practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions. MAIN OUTCOME MEASURES The primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale - International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers. RESULTS Sixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control, n = 32; intervention, n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen's d = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen's d = 0.31) and 1.3 (Cohen's d = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported. CONCLUSIONS Trial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure. TRIAL REGISTRATION Current Controlled Trials ISRCTN22464643. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.
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Affiliation(s)
- Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, St Asaph, UK
| | | | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Nicola Totton
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Kevin Mawdesley
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Claire A Hawkes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sports, Health and Exercise Science, Bangor University, Bangor, UK
| | | | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Robert T Woods
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Catherine Sackley
- School of Health and Social Care Research, King's College London, London, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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21
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Mobility one week after a hip fracture – can it be predicted? Int J Orthop Trauma Nurs 2018; 29:3-9. [DOI: 10.1016/j.ijotn.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 10/09/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
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Coelho-Junior HJ, Rodrigues B, Gonçalves IDO, Asano RY, Uchida MC, Marzetti E. The physical capabilities underlying timed "Up and Go" test are time-dependent in community-dwelling older women. Exp Gerontol 2018; 104:138-146. [PMID: 29410234 DOI: 10.1016/j.exger.2018.01.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/11/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
Timed 'Up and Go' (TUG) has been widely used in research and clinical practice to evaluate physical function and mobility in older adults. However, the physical capabilities underlying TUG performance are not well elucidated. Therefore, the present study aimed at investigating a selection of physical capacities underlying TUG performance in community-dwelling older women. Four hundred and sixty-eight apparently healthy older women independent to perform the activities of daily living (mean age: 65.8 ± 6.0 years) were recruited from two specialized healthcare centers for older adults to participate in the study. Volunteers had their medical books reviewed and underwent evaluations of anthropometric data as well as physical and functional capacities. Pearson's correlation results indicate that TUG performance was significantly associated with upper (i.e., handgrip strength) and lower (i.e., sit-to-stand) limb muscle strength, balance (i.e., one-leg stand), lower limb muscle power (i.e., countermovement jump), aerobic capacity (i.e., 6-minute walk test), and mobility (i.e., usual and maximal walking speeds). When the analyses were performed based on TUG quartiles, a larger number of physical capabilities were associated with TUG >75% in comparison with TUG <25%. Multiple linear regression results indicate that the variability in TUG (~20%) was explained by lower limb muscle strength (13%) and power (1%), balance (4%), mobility (2%), and aerobic capacity (<1%), even after adjusted by age and age plus body mass index (BMI). However, when TUG results were added as quartiles, a decrease in the impact of physical capacities on TUG performance was determined. As a whole, our findings indicate that the contribution of physical capabilities to TUG performance is altered according to the time taken to perform the test, so that older women in the lower quartiles - indicating a higher performance - have an important contribution of lower limb muscle strength, while volunteers in the highest quartile demonstrate a decreased dependence on lower limb muscle strength and an increased contribution of other physical capabilities, such as lower limb muscle power and balance.
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Affiliation(s)
- Hélio José Coelho-Junior
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, Av. Érico Veríssimo, 701, Cidade Universitária "Zeferino Vaz", Barão Geraldo, CEP: 13.083-851 Campinas, SP, Brazil; Center of Health Sciences, University of Mogi das Cruzes, Av. Dr. Cândido Xavier de Almeida Souza, 200, CEP 08780-911 Centro Cívico, Mogi das Cruzes, Brazil.
| | - Bruno Rodrigues
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, Av. Érico Veríssimo, 701, Cidade Universitária "Zeferino Vaz", Barão Geraldo, CEP: 13.083-851 Campinas, SP, Brazil
| | - Ivan de Oliveira Gonçalves
- Center of Health Sciences, University of Mogi das Cruzes, Av. Dr. Cândido Xavier de Almeida Souza, 200, CEP 08780-911 Centro Cívico, Mogi das Cruzes, Brazil; Community Center for Older People of Poá, Poá, Brazil
| | - Ricardo Yukio Asano
- Center of Health Sciences, University of Mogi das Cruzes, Av. Dr. Cândido Xavier de Almeida Souza, 200, CEP 08780-911 Centro Cívico, Mogi das Cruzes, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, Rua Arlindo Béttio, 1000 - Ermelino Matarazzo, São Paulo, SP, 03828-000, Brazil
| | - Marco Carlos Uchida
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, Av. Érico Veríssimo, 701, Cidade Universitária "Zeferino Vaz", Barão Geraldo, CEP: 13.083-851 Campinas, SP, Brazil
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
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23
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Cross-cultural validation of the Italian version of the Cumulated Ambulation Score. Int J Rehabil Res 2016; 39:160-4. [DOI: 10.1097/mrr.0000000000000165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Overgaard JA, Larsen CM, Holtze S, Ockholm K, Kristensen MT. Interrater Reliability of the 6-Minute Walk Test in Women With Hip Fracture. J Geriatr Phys Ther 2016; 40:158-166. [PMID: 27213999 DOI: 10.1519/jpt.0000000000000088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The 6-minute walk test (6MWT) is widely used as a clinical outcome measure. However, the reliability of the 6MWT is unknown in individuals who have recently experienced a hip fracture. The aim of this study was to evaluate the relative and absolute interrater reliability of the 6MWT in individuals with hip fracture. METHODS Two senior physical therapy students independently examined a convenience sample of 20 participants in a randomized order. Their assessments were separated by 2 days and followed the guidelines of the American Thoracic Society. Hip fracture-related pain was assessed with the Verbal Ranking Scale. RESULTS Participants (all women) with a mean (standard deviation) age of 78.1 (5.9) years performed the test at a mean of 31.5 (5.8) days postsurgery. Of the participants, 10 had a cervical fracture and 10 had a trochanteric fracture. Excellent interrater reliability (intraclass correlation coefficient [ICC2.1] = 0.92; 95% confidence interval, 0.81-0.97) was found, and the standard error of measurement and smallest real difference were calculated to be 21.4 and 59.4 m, respectively. Bland-Altman plots revealed no significant difference (mean of 3.2 [31.5] m, P = .83) between the 2 raters, and no heteroscedasticity was observed (r = -0.196, P = .41). By contrast, participants walked an average of 21.7 (22.5) m longer during the second trial (P = .002). Participants with moderate hip fracture-related pain walked a shorter distance than those with no or light pain during the first test (P = .04), but this was not the case during the second test (P = .25). CONCLUSION The interrater reliability of the 6MWT is excellent, and changes of more than 21.4 m (group level) and 59.4 m (individual participants with hip fracture) indicate a real change in the 6MWT. Measuring hip fracture-related pain during testing is recommended for individuals with hip fracture who undergo the 6MWT.
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Affiliation(s)
- Jan Arnholtz Overgaard
- 1Department of Rehabilitation, Municipality of Lolland, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Maribo, Denmark. 2Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 3Health Sciences Research Centre, University College Lillebaelt, Denmark. 4Department of Rehabilitation, Municipality of Lolland, Maribo, Denmark. 5Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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25
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Leegwater NC, Nolte PA, de Korte N, Heetveld MJ, Kalisvaart KJ, Schönhuth CP, Pijnenburg B, Burger BJ, Ponsen KJ, Bloemers FW, Maier AB, van Royen BJ. The efficacy of continuous-flow cryo and cyclic compression therapy after hip fracture surgery on postoperative pain: design of a prospective, open-label, parallel, multicenter, randomized controlled, clinical trial. BMC Musculoskelet Disord 2016; 17:153. [PMID: 27059990 PMCID: PMC4826534 DOI: 10.1186/s12891-016-1000-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/30/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The number of hip fractures and resulting post-surgical outcome are a major public health concern and the incidence is expected to increase significantly. The acute recovery phase after hip fracture surgery in elder patients is often complicated by severe pain, high morphine consumption, perioperative blood loss with subsequent transfusion and delirium. Postoperative continuous-flow cryocompression therapy is suggested to minimize these complications and to attenuate the inflammatory reaction that the traumatic fracture and subsequent surgical trauma encompass. Based on a pilot study in patients undergoing total hip arthroplasty for osteoarthritis, it is anticipated that patients treated with continuous-flow cryocompression therapy will have less pain, less morphine consumption and lower decrease of postoperative hemoglobin levels. These factors are associated with a shorter hospital stay and better long-term (functional) outcome. METHODS/DESIGN One hundred and sixty patients with an intra or extracapsular hip fracture scheduled for internal fixation (intramedullary hip nail, dynamic hip screw or cannulated screws) or prosthesis surgery (total hip or hemiarthroplasty) will be included in this prospective, open-label, parallel, multicenter, randomized controlled, clinical superiority trial. Patients will be allocated to two treatment arms: group 'A' will be treated with continuous-flow cryocompression therapy and compared to group 'B' that will receive standard care. Routine use of drains and/or compressive bandages is allowed in both groups. The primary objective of this study is to compare acute pain the first 72 h postoperative, measured with numeric rating scale for pain. Secondary objectives are: (non-) morphine analgesic use; adjusted postoperative hemoglobin level; transfusion incidence; incidence, duration and severity of delirium and use of psychotropic medication; length of stay; location and duration of rehabilitation; functional outcome; short-term patient-reported health outcome; general and cryotherapy related complications and feasibility. DISCUSSION This is the first randomized controlled trial that will assess the analgesic efficiacy of continuous-flow cryocompression therapy in the acute recovery phase after hip fracture surgery. TRIAL REGISTRATION www.trialregister.nl, NTR4152 (23(rd) of August 2013).
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Affiliation(s)
- Nick C. Leegwater
- />Department of Orthopedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Peter A. Nolte
- />Department of Orthopedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Niels de Korte
- />Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | | | - Casper P. Schönhuth
- />Department of Orthopedics, VU University Medical Center, Amsterdam, The Netherlands
| | - Bas Pijnenburg
- />Department of Orthopedics, Amstelland Hospital, Amstelveen, The Netherlands
| | - Bart J. Burger
- />Department of Orthopedics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Kees-Jan Ponsen
- />Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Frank W. Bloemers
- />Department of Surgery, Section of Traumasurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrea B. Maier
- />Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Barend J. van Royen
- />Department of Orthopedics, VU University Medical Center, Amsterdam, The Netherlands
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Nygard H, Matre K, Fevang JM. Evaluation of Timed Up and Go Test as a tool to measure postoperative function and prediction of one year walking ability for patients with hip fracture. Clin Rehabil 2015; 30:472-80. [PMID: 26109590 PMCID: PMC4838172 DOI: 10.1177/0269215515591039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 05/16/2015] [Indexed: 12/02/2022]
Abstract
Objective: To evaluate if the Timed Up and Go Test is a useful tool to measure postoperative function and to predict one-year results of rehabilitation in patients operated owing to hip fracture. Design: Prospective cohort study. Setting: The department of orthopaedic surgery at five hospitals in Norway. Patients were assessed five days postoperatively and after one year. Subjects: A total of 684 patients over 60 years with trochanteric or subtrochanteric hip fractures were included. A total of 171 (25%) patients died within a year and 373 (73% of patients still alive) attended follow-up one year after surgery. Main measures: Timed Up and Go Test and walking ability. Results: A total of 258 (38%) patients passed the postoperative Timed Up and Go Test. A total of 217 (56%) patients with a prefracture independent outdoor walking ability, passed the test. The average Timed Up and Go Test score was 71 seconds. A total of 171 (25%) patients could not rise from a chair without assistance; 8% of the patients with cognitive impairment, and 8% of those admitted from nursing homes, were able to pass the postoperative Timed Up and Go Test. The sensitivity and specificity of the Timed Up and Go Test in predicting walking ability one year after the operation were low. At one year follow-up, 38% of the patients not able to perform the postoperative Timed Up and Go Test, passed the test. A total of 81 (21%) patients did not use any walking-aid, 17 of them did not pass the postoperative Timed Up and Go Test. Conclusion: The Timed Up and Go Test performed the fifth postoperative day was not a suitable tool to assess functional mobility for the majority of the patients with hip fractures in our study. Neither was the postoperative Timed Up and Go Test a suitable tool to predict the walking ability one year after the operation.
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Affiliation(s)
- Heid Nygard
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Kjell Matre
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jonas Meling Fevang
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Hulsbæk S, Larsen RF, Troelsen A. Predictors of not regaining basic mobility after hip fracture surgery. Disabil Rehabil 2014; 37:1739-44. [PMID: 25350664 DOI: 10.3109/09638288.2014.974836] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Regaining basic mobility after hip fracture surgery is a milestone in the in-hospital rehabilitation. The aims were to investigate predictors for not regaining basic mobility at the fifth post-operative day and at discharge after undergoing hip fracture surgery. METHOD In a prospective cohort study 274 hip fracture patients were included. Patients with compromised ability to exercise were excluded leaving 167 patients for analysis. Patient demographics, functional level, method of operation, post-operative hemoglobin and the completion of physiotherapy was registered. Basic mobility was assessed by the Cumulated Ambulation Score. Multivariate logistic regression was performed. RESULTS Age >80 years (OR = 7.5), low prefracture functional level (OR = 3.0), not completed the physiotherapy on first post-operative day (OR = 4.6) and hemoglobin <6 mmol/L measured on first post-operative day (OR = 5.8) were significant predictors of not regaining basic mobility within the fifth post-operative day (p values: 0.04 - <0.0001). Predictors of not regaining basic mobility at discharge were: Age >80 years (OR = 4.3), prefracture functional level (OR = 7.0) and not completed the physiotherapy on first post-operative day (OR = 3.3) (p values: 0.009-<0.0001). CONCLUSIONS This study shows that patients undergoing hip fracture surgery, who are not able to complete physiotherapy on first post-operative day, are at a greater risk of not regaining basic mobility during hospitalization. This highlights the importance of physiotherapy as part of the interdisciplinary treatment. IMPLICATIONS FOR REHABILITATION Regaining abilities in basic mobility after hip fracture surgery is a primary goal of rehabilitation during hospitalization in the acute ward. The following factors are indentified to predict patients not regaining their previous level of basic mobility: Age >80 years, low prefracture functional level, patients not being able to complete the physiotherapy on the first post-operative day and hemoglobin value <6 mmol/l on the first post-operative day. In future strategies, the findings regarding both modifiable and unmodifiable factors, can be used to conduct early planning of discharge and to take actions in relation to patients who are at a risk of not regaining basic mobility.
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Affiliation(s)
- Signe Hulsbæk
- Department of Physiotherapy, Køge Hospital , Køge , Denmark and
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Kronborg L, Bandholm T, Palm H, Kehlet H, Kristensen MT. Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery. PLoS One 2014; 9:e93332. [PMID: 24699276 PMCID: PMC3974729 DOI: 10.1371/journal.pone.0093332] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/02/2014] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE To examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. DESIGN, SETTING AND PATIENTS A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. INTERVENTION A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings. MAIN OUTCOMES AND MEASURES The primary outcome was the change in training load (kg) during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength. RESULTS The strength training was commenced at a mean of 2.4 (0.7) days after surgery. The training loads (kilograms lifted) increased from 1.6 (0.8) to 4.3 (1.7) kg over 4.3 (2.2) training sessions (P<.001). The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2) to 0.61 (0.3) Nm/kg (P<.001), while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001). Only 3 of 212 sessions were not performed because of severe hip fracture-related pain. CONCLUSION AND RELEVANCE Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01616030.
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Affiliation(s)
- Lise Kronborg
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
- Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- * E-mail:
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
- Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark
- Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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Brent L, Coffey A. Patient’s perception of their readiness for discharge following hip fracture surgery. Int J Orthop Trauma Nurs 2013. [DOI: 10.1016/j.ijotn.2013.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Overgaard J, Kristensen MT. Feasibility of progressive strength training shortly after hip fracture surgery. World J Orthop 2013; 4:248-258. [PMID: 24147260 PMCID: PMC3801244 DOI: 10.5312/wjo.v4.i4.248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/15/2013] [Accepted: 09/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients.
METHODS: This prospective, single-blinded cohort study evaluated 31 community-dwelling patients from four outpatient geriatric health centres aged 60 years or older, who started a 6-wk programme at a mean of 17.5 ± 5.7 d after hip fracture surgery. The intervention consisted primarily of progressive fractured knee-extension and bilateral leg press strength training (twice weekly), with relative loads commencing at 15 and increasing to 10 repetitions maximum (RM), with three sets in each session. The main measurements included progression in weight loads, hip fracture-related pain during training, maximal isometric knee-extension strength, new mobility score, the timed up and go test, the 6-min walk test and the 10-meter fast speed walk test, assessed before and after the programme.
RESULTS: Weight loads in kilograms in the fractured limb knee-extension strength training increased from 3.3 ± 1.5 to 5.7 ± 1.7 and from 6.8 ± 2.4 to 7.7 ± 2.6, respectively, in the first and last 2 wk (P < 0.001). Correspondingly, the weight loads increased from 50.3 ± 1.9 to 90.8 ± 40 kg and from 108.9 ± 47.7 to 121.9 ± 54 kg in the bilateral leg press exercise (P < 0.001). Hip fracture-related pain was reduced, and large improvements were observed in the functional outcome measurements, e.g., the 6-min walk test improved from 200.6 ± 79.5 to 322.8 ± 68.5 m (P < 0.001). The fractured limb knee-extension strength deficit was reduced from 40% to 17%, compared with the non-fractured limb. Ten patients reported knee pain as a minor restricting factor during the last 10 RM knee-extension strength-training sessions, but with no significant influences on performance.
CONCLUSION: Progressive strength training, initiated shortly after hip fracture surgery, seems feasible and does not increase hip fracture-related pain. Progressive strength training resulted in improvement, although a strength deficit of 17% persisted in the fractured limb compared with the non-fractured limb.
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Kristensen MT. Hip fracture-related pain strongly influences functional performance of patients with an intertrochanteric fracture upon discharge from the hospital. PM R 2012. [PMID: 23182336 DOI: 10.1016/j.pmrj.2012.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. DESIGN Prospective observational study. SETTING A 20-bed orthopedic hip fracture unit. PATIENTS Fifty-five cognitively intact patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery. METHODS All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days after surgery. MAIN OUTCOME MEASUREMENTS The Timed Up & Go (TUG) test, supervised by a physical therapist, was used to evaluate functional performance, and a 5-point verbal ranking scale (0 = no pain to 4 = intolerable pain) was used to evaluate pain. RESULTS Patients took an average of 22.7 ± 11.7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during testing (P < .001), with associated poorer performances on the TUG test (29.4 ± 12.8 seconds versus 18.3 ± 8.5 seconds). Univariate analysis showed that TUG scores were associated with age, prefracture function evaluated by the New Mobility Score, fracture type, day of TUG performance, and pain intensity. Multivariate linear regression analyses (fracture type not included) showed that only greater age (B = 0.34), low prefracture function (B = 7.9), and experiencing moderate to severe pain (B = 8.7) were independently associated with having a poorer TUG score. CONCLUSIONS Hip fracture-related pain primarily compromises the functional performance of patients with an intertrochanteric hip fracture upon discharge from hospital. Physical therapists should be involved in new and optimized fracture-type stratified pain management strategies.
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Affiliation(s)
- Morten Tange Kristensen
- Department of Physical Therapy, 236, and Orthopedic Surgery, Hvidovre University Hospital, Kettegaard Alle 30, Copenhagen DK-2650, Denmark.
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Functional and radiographic outcomes of intertrochanteric hip fractures treated with calcar reduction, compression, and trochanteric entry nailing. J Orthop Trauma 2012; 26:148-54. [PMID: 21918483 DOI: 10.1097/bot.0b013e31821e3f8c] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Shortening after intertrochanteric hip fractures with sliding constructs is an increasingly recognized problem by the orthopaedic community. It often results in a limb length discrepancy causing maladaptation of the abductor lever arm. Functional limitations can also result from altered hip biomechanics and negatively influence patient outcomes. We hypothesized that with trochanteric entry nailing, calcar reduction, and intraoperative compression, a near-normal restoration of gait parameters and satisfactory outcomes can be achieved. DESIGN Level 4, prospective descriptive study. SETTINGS Level 1 trauma care center. PATIENTS/PARTICIPANTS Fifty-eight patients with intertrochanteric hip fractures were managed operatively from 2007 to 2008. A strict exclusion criterion was used to analyze the data of interest for a final cohort of 30 patients. INTERVENTION Stable fixation was achieved with trochanteric entry nail after calcar reduction and intraoperative compression of the fracture site. Patients were grouped into stable (n = 17) and unstable (n = 13) fracture types based on the OTA classification. OUTCOME/MEASUREMENTS: Postoperative collapse was measured as telescoping of the lag screw from lateral cortex and blade tip migration within the femoral head. Alteration in femoral head offset and abductor lever arm was measured at the last follow-up visit. Gait parameters were recorded and compared with contralateral side at 6-week, 3-, 6-, and 12-month follow-up visits. Functional outcomes were assessed through 36-item short form health survey (version 2) and Harris Hip Scores at 1 year. RESULTS Fracture type (stable or unstable) significantly predicted telescoping (P = 0.007). Mean telescoping was 3.3 mm (SD = 2.41 mm) in the unstable group versus 1.2 mm (SD = 0.81 mm) in the stable group (P = 0.004). The stable group recovered 95% of the single limb stance versus 91% in the unstable group, at 1 year. (P = 0.02). Return of single limb stance improved from 76% to 95% between 6 weeks and 6 months. No improvement in gait was seen after 6 months (P > 0.05). The average scores on the physical and mental components of 36-item short form health survey and Harris Hip Scores were 44, 53, and 89, respectively. The radiographic union rate was 100%. There was 1 (3%) screw cutout that did not require a revision surgery in our series. There were no cases with implant failure, femur fracture, or any wound complications. CONCLUSIONS Satisfactory functional outcomes with near-normal gait restoration can be achieved in cases of intertrochanteric hip fractures with an emphasis on calcar reduction and compression after fixation with trochanteric entry nail. LEVEL OF EVIDENCE Therapeutic Level IV. See page 128 for a complete description of levels of evidence.
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Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: how are we measuring outcome? Injury 2011; 42:1205-13. [PMID: 21232743 DOI: 10.1016/j.injury.2010.12.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/03/2010] [Accepted: 12/16/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with proximal femoral fractures present a difficult problem to health care systems in view of their complex presentations and co-morbidities. Traditionally, the focus of outcome measurement for this patient group has been on mortality and surgical implant success. Increasing recognition of the need to diversify outcome measurements has led to the creation and use of a number of outcome scales. We sought to examine how these scales are being used in the current literature. METHODS Abstracts to over 4000 papers related to proximal femoral fracture research were screened to identify commonly used scales in the five main categories of general quality of life measures (QoL), Activities of Daily Living scales (ADL), mobility and physical performance scales, disease-specific scales and hip-specific scales. The 14 identified scales were then searched for directly, and papers analysed for scale usage, timing and interpretation. RESULTS ADL scales were the most commonly used group, followed by QoL measures, which are validated for elderly patients. Scale timing and use varied widely between studies. A large number of scales were found in addition to the 14 identified scales. None of the 14 identified scales were validated for the proximal femoral fracture population. DISCUSSION A good scale must be appropriate in content, method and clinical utility. Its method of application must be reliable, responsive, and validated for the population in question. Outcome scale usage was difficult to assess in proximal femoral fracture research due to difficulties in isolating the relevant research, and in differences in scale timing and interpretation. Scale prevalence was skewed by use by specific research groups. CONCLUSION There is no single unifying scale in widespread use for proximal femoral fracture patients. We would recommend the validation of commonly used scales for this population, and would advise the use of scales from more than one category to assess outcome.
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Affiliation(s)
- Lynn Hutchings
- Department of Trauma & Orthopaedics, Frenchay Hospital, North Bristol NHS Trust, United Kingdom.
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Kristensen MT, Ekdahl C, Kehlet H, Bandholm T. How many trials are needed to achieve performance stability of the Timed Up & Go test in patients with hip fracture? Arch Phys Med Rehabil 2010; 91:885-9. [PMID: 20510979 DOI: 10.1016/j.apmr.2010.01.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 01/23/2010] [Accepted: 01/26/2010] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the number of trials needed to achieve performance stability of the Timed Up & Go (TUG) test using a standardized walking aid in patients with hip fracture who are allowed full weight bearing (FWB). DESIGN Prospective methodologic study. SETTING An acute 14-bed orthopedic hip fracture unit. PARTICIPANTS Patients (N=122; 89 women, 33 men) with hip fracture with a median age (25%-75%, quartiles) of 80 (67-85) years performed the TUG on hospital discharge to their own home (n=115) or further inpatient rehabilitation (n=7). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES After a demonstration by a physical therapist how to perform the TUG with a standardized walking aid (a 4-wheeled rollator), the patients performed 6 timed TUG trials with up to 1-minute seated rest intervals. The participants were given a few minutes to familiarize with the rollator before commencing the timed trials. Repeated-measures analysis of variance (ANOVA) with Bonferroni corrections were used to examine the number of trials needed to ensure statistically stable TUG scores. RESULTS A total of 106 (87%) patients performed all 6 TUG trials, while 120 patients performed a minimum of 3 timed trials. Repeated-measures ANOVAs of both groups showed that TUG scores improved significantly (P< or =.007) up to and including the third TUG trial. CONCLUSIONS These results suggest that the original TUG manual, described as 1 practice trial followed by 1 timed trial, needs modification when used in patients with hip fracture who are allowed FWB. The best (fastest) of 3 timed TUG trials performed with a standardized walking aid is recommended.
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Affiliation(s)
- Morten T Kristensen
- Division of Physical Therapy, Health Sciences Center, Lund University, Lund, Sweden.
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Kristensen MT, Foss NB, Ekdahl C, Kehlet H. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop 2010; 81:296-302. [PMID: 20450426 PMCID: PMC2876830 DOI: 10.3109/17453674.2010.487240] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Clinicians need valid and easily applicable predictors of outcome in patients with hip fracture. Adjusting for previously established predictors, we determined the predictive value of the New Mobility score (NMS) for in-hospital outcome in patients with hip fracture. PATIENTS AND METHODS We studied 280 patients with a median age of 81 (interquartile range 72-86) years who were admitted from their own homes to a special hip fracture unit. Main outcome was the regain of independence in basic mobility, defined as. independence in getting in and out of bed, sitting down and standing up from a chair, and walking with an appropriate walking aid. The Cumulated Ambulation score was used to evaluate basic mobility. Predictor variables were NMS functional level before fracture, age, sex, fracture type, and mental and health status. RESULTS Except for sex, all predictor variables were statistically significant in univariate testing. In multiple logistic regression analysis, only age, NMS functional level before fracture, and fracture type were significant. Thus, patients with a low prefracture NMS and/or an intertrochanteric fracture would be 18 and 4 times more likely not to regain independence in basic mobility during the hospital stay, respectively, than patients with a high prefracture level and a cervical fracture, respectively. The model was statistically stable and correctly classified 84% of cases. INTERPRETATION The NMS functional level before fracture, age, and fracture type facilitate prediction of the in-hospital rehabilitation potential after hip fracture surgery.
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Affiliation(s)
| | - Nicolai B Foss
- Anesthesiology, Hvidovre Hospital, Copenhagen University
| | - Charlotte Ekdahl
- Division of Physical Therapy, Health Sciences Center, Lund UniversitySweden
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen UniversityDenmark
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Herman T, Giladi N, Hausdorff JM. Properties of the 'timed up and go' test: more than meets the eye. Gerontology 2010; 57:203-10. [PMID: 20484884 DOI: 10.1159/000314963] [Citation(s) in RCA: 288] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/19/2010] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The 'timed up and go' test (TUG) is a simple, quick and widely used clinical performance-based measure of lower extremity function, mobility and fall risk. We speculated that its properties may be different from other performance-based tests and assessed whether cognitive function may contribute to the differences among these tests in a cohort of healthy older adults. OBJECTIVE To evaluate psychometric properties of the TUG in healthy older adults in comparison to the Berg balance test (BBT) and the Dynamic Gait Index (DGI). METHODS The TUG, DGI and BBT were assessed in 265 healthy older adults (76.4 ± 4.3 years; 58.3% women) who participated in a 3-year prospective study. The Mini-Mental State Examination, digit span and verbal fluency measured cognitive function. The one-sample Kolmogorov-Smirnov test evaluated deviations from a normal distribution and Pearson's correlation coefficients quantified associations. RESULTS The mean scores of the BBT, DGI and TUG were: 54.0 ± 2.4, 22.8 ± 1.5, 9.5 ± 1.7 s, respectively. The BBT and the DGI were not normally distributed (p < 0.001), but the TUG was (p = 0.713). The TUG times were mildly associated (p < 0.01) with digit span and verbal fluency and were related to future falls, while the BBT and the DGI were not. CONCLUSIONS The TUG appears to be an appropriate tool for clinical assessment of functional mobility even in healthy older adults. It does not suffer from ceiling effect limitations, is normally distributed and is apparently related to executive function. The BBT and the DGI do not share these beneficial properties. Perhaps the transferring and turning components of the TUG help to convert this relatively simple motor task into a more complex measure that also depends on cognitive resources.
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Affiliation(s)
- Talia Herman
- Laboratory for Gait Analysis and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Kristensen MT, Andersen L, Bech-Jensen R, Moos M, Hovmand B, Ekdahl C, Kehlet H. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture. Clin Rehabil 2010; 23:1116-23. [PMID: 19923208 DOI: 10.1177/0269215509342330] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN An intertester reliability study. SETTING An acute 20-bed orthopaedic hip fracture unit. SUBJECTS Fifty consecutive patients with a median age of 83 (25-75% quartile, 68-86) years. INTERVENTIONS The CAS, which describes the patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability - was assessed by two independent physiotherapists at postoperative median day 3. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent of human assistance). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent ambulation. MAIN MEASURES Reliability was evaluated using weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). RESULTS The kappa coefficient, the SEM and the SRD in the three activities and the total CAS were >or=0.92, <or=0.20 and <or=0.55 CAS points, respectively. CONCLUSIONS The intertester reliability of the CAS is very high, and a change of more than 0.20 and 0.55 CAS points for the total CAS indicates a real change in basic mobility, at group level and for an individual patient, respectively.
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Kristensen MT, Bandholm T, Holm B, Ekdahl C, Kehlet H. Timed up & go test score in patients with hip fracture is related to the type of walking aid. Arch Phys Med Rehabil 2009; 90:1760-5. [PMID: 19801068 DOI: 10.1016/j.apmr.2009.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/04/2009] [Accepted: 05/04/2009] [Indexed: 12/21/2022]
Abstract
UNLABELLED Kristensen MT, Bandholm T, Holm B, Ekdahl C, Kehlet H. Timed Up & Go test score in patients with hip fracture is related to the type of walking aid. OBJECTIVE To determine the relationship between Timed Up & Go (TUG) test scores and type of walking aid used during the test, and to determine the feasibility of using the rollator as a standardized walking aid during the TUG in patients with hip fracture who were allowed full weight-bearing (FWB). DESIGN Prospective methodological study. SETTING An acute orthopedic hip fracture unit at a university hospital. PARTICIPANTS Patients (N=126; 90 women, 36 men) with hip fracture with a mean age +/- SD of 74.8+/-12.7 years performed the TUG the day before discharge from the orthopedic ward. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The TUG was performed with the walking aid the patient was to be discharged with: a walker (n=88) or elbow crutches (n=38). In addition, all patients also performed the TUG using a rollator. RESULTS Patients who performed the TUG with a walker were on average 13.6 (95% confidence interval [CI], 11.2-16.1) seconds faster using a rollator compared with the walker (P<.001). Correspondingly, patients who performed the TUG with crutches were on average 3.5 (95% CI, 1.5-5.4) seconds faster using a rollator compared with elbow crutches (P=.001). In both patient groups, the between walking-aid scores were strongly correlated (r>.833, P<.001). CONCLUSIONS TUG scores are significantly related to the type of walking aid used during the test in patients with hip fracture who are allowed FWB when discharged from the hospital, but all patients were able to perform the TUG using the rollator as a standardized walking aid. Our findings indicate the importance of using a standardized walking aid when evaluating changes or comparing TUG scores in patients with hip fracture.
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Affiliation(s)
- Morten T Kristensen
- Department of Health Sciences, Division of Physical Therapy, Lund University, Lund, Sweden.
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