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Pedersen LT, Ipsen JA, Bruun IH, Egebæk HK, Andersen PT, Viberg B. Association between patient activation level and functional outcomes in older adults with hip fractures. Arch Gerontol Geriatr 2024; 124:105472. [PMID: 38728823 DOI: 10.1016/j.archger.2024.105472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.
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Affiliation(s)
- Lars Tobiesen Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark Esbjerg, Denmark.
| | - Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Kraaijkamp JJM, Stijntjes M, De Groot JH, Chavannes NH, Achterberg WP, van Dam van Isselt EF. Movement Patterns in Older Adults Recovering From Hip Fracture. J Aging Phys Act 2024; 32:312-320. [PMID: 38215728 DOI: 10.1123/japa.2023-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 01/14/2024]
Abstract
The aim of this study was to quantify physical activity and sedentary behavior in older adults recovering from hip fracture and to identify groups based on movement patterns. In this cross-sectional cohort study, older adults (≥70 years) were included 3 months after surgery for proximal femoral fracture. Patients received an accelerometer for 7 days. Demographics and outcomes related to physical function, mobility, cognitive functions, quality of life, and hip fracture were assessed. In total, 43 patients with sufficient accelerometer wear time were included. Across all groups, participants engaged in very low levels of physical activity, spending an average of 11 hr/day in prolonged sedentary behavior. Based on the extracted components from a principal component analysis, three groups with substantial differences in levels of physical activity and sedentary behavior could be distinguished.
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Affiliation(s)
- Jules J M Kraaijkamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- ZZG Zorggroep, Nijmegen, the Netherlands
| | - Marjon Stijntjes
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
- BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Jurriaan H De Groot
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Noeske KE, Snowdon DA, Ekegren CL, Harding KE, Prendergast LA, Peiris CL, Shields N, O'Halloran PD, Porter J, Watts JJ, Taylor NF. Walking self-confidence and lower levels of anxiety are associated with meeting recommended levels of physical activity after hip fracture: a cross-sectional study. Disabil Rehabil 2024:1-7. [PMID: 38635302 DOI: 10.1080/09638288.2024.2338195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture. MATERIALS AND METHODS Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender. RESULTS Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds. CONCLUSION Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.
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Affiliation(s)
- Kate E Noeske
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - David A Snowdon
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Academic Unit, Peninsula Health, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Luke A Prendergast
- School of Computing, Engineering and Mathematical Sciences, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- The Royal Melbourne Hospital, Allied Health, Parkville, Australia
| | - Nora Shields
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Australia
| | - Paul D O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), Deakin University School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Hämäläinen O, Tirkkonen A, Savikangas T, Alén M, Sipilä S, Hautala A. Low physical activity is a risk factor for sarcopenia: a cross-sectional analysis of two exercise trials on community-dwelling older adults. BMC Geriatr 2024; 24:212. [PMID: 38424514 PMCID: PMC10905947 DOI: 10.1186/s12877-024-04764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Physical inactivity is an important factor in the development of sarcopenia. This cross-sectional study explores the prevalence of sarcopenia and associations of physical activity (PA) with sarcopenia in two exercise trial populations. These study groups are clinically meaningful community-dwelling populations at increased risk for sarcopenia: older adults not meeting the PA guidelines and those with a recent hip fracture (HF). METHODS Data from 313 older adults who did not meet the PA guidelines (60% women; age 74.5 ± 3.8, body mass index 27.9 ± 4.7) and 77 individuals with HF diagnosed on average 70 ± 28 days earlier (75% women; age 79.3 ± 7.1, body mass index 25.3 ± 3.6) were included in this study. Grip strength and muscle mass (Dual-energy X-ray absorptiometry [DXA] in older adults not meeting the PA guidelines and bioimpedance analysis in participants with HF) were used to assess sarcopenia according to the European Working Group in Older People 2019 (EWGSOP2) criteria. The current level of PA was self-reported using a question with seven response options in both study groups and was measured with a hip-worn accelerometer for seven consecutive days in older adults not meeting the PA guidelines. RESULTS The prevalence of sarcopenia and probable sarcopenia was 3% (n = 8) and 13% (n = 41) in the older adults not meeting the PA guidelines and 3% (n = 2) and 40% (n = 31) in the HF group, respectively. In the age- and sex-adjusted logistic regression model, the lowest levels of self-reported PA were associated with increased probable sarcopenia and sarcopenia risk in older adults not meeting the PA guidelines (OR 2.8, 95% CI, 1.3-6.1, p = 0.009) and in the HF group (OR 3.9, 95% CI, 1.4-11.3, p = 0.012). No significant associations between accelerometer-measured PA and probable sarcopenia or sarcopenia were found. CONCLUSIONS Probable sarcopenia is common among community-dwelling older adults not meeting the PA guidelines and very common among individuals recovering from HF who are able to be involved in exercise interventions. In addition, since low PA is associated with higher probable sarcopenia and sarcopenia risk, it is recommended to screen for sarcopenia and promote regular physical activity to prevent sarcopenia in these populations.
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Affiliation(s)
- Onni Hämäläinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Anna Tirkkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Tiina Savikangas
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alén
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Arto Hautala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Ribbe Kelso L, Stockton K, Mahendran N, Brauer SG, Rosbergen I. The influence of communal spaces on patient activity in rehabilitation: a mixed methods study. Disabil Rehabil 2024; 46:309-321. [PMID: 36587814 DOI: 10.1080/09638288.2022.2160834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. MATERIALS AND METHODS A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. RESULTS Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7-36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1-38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. CONCLUSION Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments.IMPLICATIONS FOR REHABILITATIONOptimising patient activity throughout the day in inpatient rehabilitation is important to support recovery.Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood.Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed.
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Affiliation(s)
- Lucy Ribbe Kelso
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kellie Stockton
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Niruthikha Mahendran
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid Rosbergen
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Department of Physiotherapy, Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
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Kirk AG, Kimmel LA, Behm KJ, Peiris CL, Ekegren CL. Validity of the activPAL and ActiGraph for measuring sitting time and steps in hospitalised orthopaedic patients with altered weight bearing. Disabil Rehabil 2024; 46:378-386. [PMID: 36541196 DOI: 10.1080/09638288.2022.2157896] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the criterion validity of the activPAL and ActiGraph for measuring steps and sitting/sedentary time, compared to observation, in people hospitalised following orthopaedic lower limb injury who were weight bearing (WB) (i.e., walking) or non-weight bearing (NWB) (i.e., hopping). MATERIALS AND METHODS Participants wore an activPAL and ActiGraph on the hip/thigh/unaffected (UA)/affected ankle (AA) while completing bouts of walking and sitting. Lin's concordance correlation coefficient, Bland-Altman methods, and ratio of agreement were used to compare device-measured to observed (videoed) step count, sitting/sedentary time. RESULTS In 42 participants, the ActiGraph demonstrated excellent concordance with the observed step count when worn on the ankle (LCC 0.91-0.92) compared to the hip (LCC 0.56) in participants that were WB. The ActiGraph AA achieved the highest concordance (LCC 0.71) with observed steps in participants NWB. The activPAL had poor concordance with observed steps, particularly at slow gait speeds, in participants that were WB (LCC 0.38-0.46), however was less influenced by gait speed and had good concordance in NWB participants (LCC 0.52-0.69). The activPAL (LCC 0.79-0.88) and ActiGraph UA (LCC 0.94) showed excellent concordance with observed sitting and sedentary time, respectively. CONCLUSIONS The ActiGraph worn at the ankle provided the most valid measure of steps in people who are WB and NWB following orthopaedic injury, while the activPAL was best for measuring sitting time.Implications for rehabilitationTo accurately measure both steps and sitting time in people with lower limb orthopaedic injuries, a combination of activity monitors should be used (i.e., ActiGraph for steps, activPAL for sitting time).The ActiGraph device when worn on the ankle demonstrated the strongest agreement with observed step count in people who were weight bearing and non-weight bearing.Caution is needed when using thigh- or hip-worn devices in people who walk slowly.
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Affiliation(s)
- Asher G Kirk
- Department of Physiotherapy, Alfred Health, Prahran, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Prahran, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kate J Behm
- Department of Physiotherapy, Alfred Health, Prahran, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Christina L Ekegren
- Department of Physiotherapy, Alfred Health, Prahran, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Australia
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van Dartel D, Wang Y, Hegeman JH, Vollenbroek-Hutten MMR. Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study. JMIR Rehabil Assist Technol 2023; 10:e45307. [PMID: 38032703 PMCID: PMC10727481 DOI: 10.2196/45307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/25/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions. OBJECTIVE This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home. METHODS The physical activity of patients aged ≥70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F1-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F1-score for all physical activity patterns together. RESULTS The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F1-score=1) and a 100% correct classification of the 2 most common physical activity patterns. CONCLUSIONS Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves.
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Affiliation(s)
- Dieuwke van Dartel
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Ying Wang
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Ziekenhuisgroep Twente Academy, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Johannes H Hegeman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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Cupp MA, Beaudoin FL, Hayes KN, Riester MR, Berry SD, Joshi R, Zullo AR. Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults. J Am Med Dir Assoc 2023; 24:971-977.e4. [PMID: 37080246 PMCID: PMC10293035 DOI: 10.1016/j.jamda.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Pain management in post-acute care (PAC) requires careful balance, with both opioid use and inadequate pain treatment linked to poor outcomes. We describe opioid use among older adults following discharge from PAC for hip fracture in skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). DESIGN Retrospective cohort. SETTING AND PARTICIPANTS Medicare beneficiaries with Medicare Provider Analysis (MedPAR) claims, aged 66 years and older with a hip fracture hospitalization between 2012 and 2018 followed by PAC in SNFs or IRFs and then discharge to the community. METHODS Individuals were followed from PAC discharge for up to 1 year to assess opioid use. Covariate-standardized risk ratios (RR) and risk differences (RD) for opioid use within 7 days of PAC discharge were estimated via parametric g-formula with modified Poisson regression, and hazard ratios (HRs) for any post-PAC opioid use and long-term opioid use via Fine-Gray sub-distribution hazards regression. RESULTS Of 101,021 individuals, 80% (n = 80,495) were discharged from SNFs and 20% (n = 20,526) from IRFs. Opioids were dispensed to 50,433 patients (50%) overall and the 1-year cumulative incidence was notably higher in IRF (68%) than SNF (46%) patients. The adjusted risk of discharge from PAC with an opioid was 41% lower after SNFs versus IRFs [RR: 0.59; 95% confidence limits (CLs): 0.57-0.61; and RD: -0.16; 95% CLs: -0.17 to -0.15]. The adjusted rate of any opioid use in the year after PAC discharge was 44% lower (HR: 0.56; 95% CLs: 0.54-0.57) and of long-term opioid use was 17% lower (HR: 0.83; 95% CLs: 0.80-0.87) after SNFs versus IRFs. CONCLUSIONS AND IMPLICATIONS Opioid use is highly prevalent upon discharge from PAC after hip fracture, with lower use after SNF versus IRF care. Future research should assess the benefits and harms of post-PAC opioid prescribing and whether care practices during PAC can be improved to optimize long-term opioid use.
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Affiliation(s)
- Meghan A Cupp
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Kaleen N Hayes
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Richa Joshi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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van Dartel D, Wang Y, Hegeman JH, Vermeer M, Vollenbroek-Hutten MMR. Patterns of physical activity over time in older patients rehabilitating after hip fracture surgery: a preliminary observational study. BMC Geriatr 2023; 23:373. [PMID: 37328743 PMCID: PMC10276437 DOI: 10.1186/s12877-023-04054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND To investigate patterns of continuously monitored physical activity in older patients rehabilitating after hip fracture surgery and the association with patient characteristics. METHODS Physical activity of surgically treated hip fracture patients aged 70 years or older, who were rehabilitating at a skilled nursing home, was continuously monitored using a tri-axial accelerometer. The intensity of physical activity per day was calculated from the accelerometer signals to describe the daily physical activity levels of the enrolled patients. The patterns of three different aspects of physical activity were investigated: overall physical activity, overall variability, and day-to-day variability. Two experts in the geriatric rehabilitation field helped identifying unique physical activity patterns for each aspect based on visual analysis. Eighteen healthcare professionals independently classified each patient in one of the predefined patterns for each aspect. Differences between physical activity patterns and patient characteristics were assessed using a Kruskal-Wallis or Fisher's Exact Test. RESULTS Physical activity data from 66 older patients were used in this preliminary study. A total of six unique patterns were identified for overall physical activity and overall variability, and five unique patterns for the day-to-day variability. The most common pattern found for the overall physical activity and day-to-day variability had a S-shape, which first slowly increased, then steeply increased, and subsequently flattened (n = 23, 34.8%). A N-shape pattern was found the most common pattern for overall variability, which first slowly increased, then steeply increased, then decreased and lastly increased (n = 14, 21.2%). The functionality at admission to rehabilitation, measured with the Barthel Index, and the duration of rehabilitation stay differed between the patterns of physical activity. CONCLUSIONS Multiple patterns of physical activity among older patients during hip fracture rehabilitation were found in this preliminary study. The functionality at admission to rehabilitation and the duration of rehabilitation stay were associated with the different patterns found in this study. Results of this study highlight the importance of personalized hip fracture treatment.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Ying Wang
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Johannes H. Hegeman
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Miriam M. R. Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Drienerlolaan 5, 7500 AE Enschede, the Netherlands
- Board of Directors, Medisch Spectrum Twente, Enschede, The Netherlands
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10
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Right Unilateral Spatial Neglect Improves with Intrinsic Motivation. Case Rep Neurol Med 2022; 2022:4828549. [PMID: 36340934 PMCID: PMC9633176 DOI: 10.1155/2022/4828549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background. In the acute phase of stroke, it is well known that the incidence and severity of unilateral spatial neglect (USN) are more significant in the right hemisphere injuries. Still, the detection of USN in left hemisphere injuries has been increasing in recent years. This trend is because behavioral assessments have prevented the exclusion of patients who are difficult to assess for USN or apathy using conventional paper-and-pencil tests (e.g., aphasia). Right USN and post-stroke apathy share many common lesions. Therefore, clinical symptoms may overlap, but little validation considers this. Case Study. A man (62 years old) determined to have the right USN and apathy was treated for six weeks in 3 terms. In the first term (weeks 1 to 2), the patient was treated for the right USN by conventional therapy. In the second term (3–4 weeks), treatment for right USN and apathy by goal-directed therapy based on affinity behavior was implemented. In the third term (5–6 weeks), goal-directed therapy based on affinity behavior was discontinued, and treatment was returned to conventional therapy only. In the second term (goal-directed therapy based on affinity behavior), the improvement in patients' apathy (clinical assessment for spontaneity) was more significant than the effect size in the third term (conventional therapy). There were no significant differences in USN (catherine bergego scale) and intrinsic motivation (pittsburgh rehabilitation participation scale). However, the effect size in the second term tended to be larger than in the third term (conventional therapy). Clinical Rehabilitation Impact. This report aims to demonstrate the limitations of current treatment for cases determined to have both right USN and apathy. Second, to assess the extent to which this new intervention can complement the limitations of current treatment.
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11
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Soukkio PK, Suikkanen SA, Kukkonen‐Harjula KT, Kautiainen H, Hupli MT, Aartolahti EM, Kääriä SM, Pitkälä KH, Sipilä S. Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT. J Am Geriatr Soc 2022; 70:2561-2570. [PMID: 35582993 PMCID: PMC9790677 DOI: 10.1111/jgs.17824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/12/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. METHODS Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged ≥60 years, Mini-Mental State Examination (MMSE) score of ≥12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. RESULTS Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. CONCLUSION A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.
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Affiliation(s)
- Paula K. Soukkio
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote)LappeenrantaFinland,Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland,Gerontology Research Center and Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Sara A. Suikkanen
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote)LappeenrantaFinland,Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | | | - Hannu Kautiainen
- Department of General PracticeUniversity of HelsinkiHelsinkiFinland
| | - Markku T. Hupli
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote)LappeenrantaFinland
| | - Eeva M. Aartolahti
- Institute of RehabilitationJAMK University of Applied SciencesJyväskyläFinland
| | | | - Kaisu H. Pitkälä
- Department of General PracticeUniversity of HelsinkiHelsinkiFinland,Unit of Primary Health CareHelsinki University HospitalHelsinkiFinland
| | - Sarianna Sipilä
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland,Gerontology Research Center and Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
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12
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Connelly DM. Recovery in Mobility by Community-Living Older Adults following Fragility Hip Fracture. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2021.2008086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise M. Connelly
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario London Ontario, Canada
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13
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Patwary MJ, Cao W, Wang XZ, Haque MA. Fuzziness based semi-supervised multimodal learning for patient’s activity recognition using RGBDT videos. Appl Soft Comput 2022. [DOI: 10.1016/j.asoc.2022.108655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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14
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Application of a Multicomponent Exercise Program on Functional Capacity in Hip Fractures in Hospitalized Older Adults. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Taylor JB, Ford KR, Queen RM, Owen EC, Gisselman AS. Incorporating Internal and External Training Load Measurements in Clinical Decision Making After ACL Reconstruction: A Clinical Commentary. Int J Sports Phys Ther 2021; 16:565-578. [PMID: 33842052 PMCID: PMC8016425 DOI: 10.26603/001c.21152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/11/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Poor outcomes after anterior cruciate ligament reconstruction (ACLr), including the relatively high risk of suffering a subsequent ACL injury, suggest the need to optimize rehabilitation and return-to-sport testing. The purpose of this commentary is to introduce clinicians to the concept of monitoring training load during rehabilitation, to review methods of quantifying internal and external loads, and to suggest ways that these technologies can be incorporated into rehabilitation progressions and return-to-sport decisions after anterior ACLr. DESCRIPTION OF TOPIC WITH RELATED EVIDENCE Quantifying and identifying the effects of training load variables, external (distance, impacts, decelerations) and internal (heart rate, heart rate variability) workload, during rehabilitation can indicate both positive (improved physical, physiological, or psychological capacity) or negative (heightened risk for injury or illness) adaptations and allow for the ideal progression of exercise prescription. When used during return-to-sport testing, wearable technology can provide robust measures of movement quality, readiness, and asymmetry not identified during performance-based testing. DISCUSSION / RELATION TO CLINICAL PRACTICE Researchers have reported the actual in-game demands of men and women of various ages and competition levels during multi-directional sport. Wearable technology can provide similar variables during rehabilitation, home exercise programs, and during on-field transition back to sport to ensure patients have met the expected fitness capacity of their sport. Additionally, clinicians can use internal load measures to objectively monitor patient's physiological responses to rehabilitation progressions and recovery rather than relying on subjective patient-reported data. LEVEL OF EVIDENCE 5.
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16
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Wang D, Cai J, Zeng Z, Gao X, Shao X, Ding Y, Feng X, Jing D. The interactions between mTOR and NF-κB: A novel mechanism mediating mechanical stretch-stimulated osteoblast differentiation. J Cell Physiol 2020; 236:4592-4603. [PMID: 33289098 DOI: 10.1002/jcp.30184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
Mechanical stretch is known to promote osteoblast differentiation in vitro and accelerate bone regeneration in vivo, whereas the relevant mechanism remains unclear. Recent studies have shown the importance of reciprocal interactions between mammalian target of rapamycin (mTOR) and nuclear factor kappa B (NF-κB; two downstream molecules of Akt) in the regulation of tumor cells. Thus, we hypothesize that mTOR and NF-κB as well as their interconnection play a critical role in mediating stretch-induced osteogenic differentiation in osteoblasts. We herein found that mechanical stretch (10% elongation at six cycles/min) significantly promoted the expression of osteoblast differentiation-related markers (including ALP, BMP2, Col1α, OCN, and Runx2) in osteoblast-like MG-63 cells, accompanied by increased mTOR phosphorylation and NF-κB p65 phosphorylation and nuclear translocation. Blockade of mTOR by antagonist or small interfering RNA suppressed osteogenesis-related gene expression in response to mechanical stretch, whereas inhibition of NF-κB further increased stretch-induced osteoblast differentiation. Moreover, inhibition of mTOR decreased the phosphorylation of NF-κB, and blockade of NF-κB reduced the mTOR activation in MG63 cells under mechanical stretch. Coinhibition of mTOR and NF-κB abolishes the alteration of osteogenic differentiation induced by single mTOR or NF-κB inhibition under mechanical stretch, which is equivalent to the noninhibition level for osteoblasts under mechanical stretch. The expression levels of osteogenic differentiation in osteoblasts after inhibition of Akt were similar to those after co-inhibition of mTOR and NF-κB under mechanical stretch. This study for the first time reveals the reciprocal interconnection between mTOR and NF-κB in osteoblasts under mechanical stretch and indicates that mTOR and NF-κB as well as their interactions play a key role in the regulation of cellular homeostasis of osteoblasts in response to mechanical stretch. These findings are helpful for enriching our basic knowledge of the molecular mechanisms of osteoblast mechanotransduction, and also providing insight into the clinical therapeutic modality associated with mechanical stretch (e.g., distraction osteogenesis).
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Affiliation(s)
- Dan Wang
- Laboratory of Tissue Engineering, Faculty of Life Sciences, Northwest University, Xi'an, China
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Jing Cai
- Department of Diagnostics, College of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Zhaobin Zeng
- Department of Stomatology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), Shenyang, China
| | - Xue Gao
- Laboratory of Tissue Engineering, Faculty of Life Sciences, Northwest University, Xi'an, China
| | - Xi Shao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Yuanjun Ding
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xue Feng
- Department of Cell Biology, School of Medicine, Northwest University, Xi'an, China
| | - Da Jing
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
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17
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Lang CE, Barth J, Holleran CL, Konrad JD, Bland MD. Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field. SENSORS 2020; 20:s20205744. [PMID: 33050368 PMCID: PMC7601835 DOI: 10.3390/s20205744] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
- Correspondence:
| | - Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jeff D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
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18
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Taylor NF, Peiris CL, Thompson AL, Prendergast LA, Harding KE, Hau R, Shields N. Association between physical activity and short-term physical function changes after hip fracture: An observational study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1876. [PMID: 32918389 DOI: 10.1002/pri.1876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/18/2020] [Accepted: 08/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE To investigate whether physical activity levels are predictive of short-term changes in physical function for people discharged to independent living in the community following withdrawal of rehabilitation services after hip fracture; and to describe short-term recovery in physical activity, physical function, walking confidence, health-related quality of life and walking participation. METHODS This prospective cohort study comprised 57 older adults (39 females, mean age 80.4, SD 8.4 years) living independently in the community after hip fracture. Accelerometer-based physical activity, physical function (Functional Independence Measure [FIM], de Morton Mobility Index, Frenchay Activities Index and Participation in outdoor walking), walking confidence and health-related quality of life were measured after discharge from rehabilitation services (baseline) and 12 weeks later. Multiple linear regression analyses determined the ability of physical activity (daily steps), walking self-confidence, health-related quality of life and demographic factors (age, sex and time since fracture) to predict Week 12 physical function using Week 0 physical function as a covariate. RESULTS Participants at baseline averaged 4439 daily steps which did not change 12 weeks later. There were small increases in all measures of physical function and walking confidence, but not health-related quality of life. Increased walking self-confidence was associated with an increase in FIM total, FIM mobility and de Morton Index scores. Physical activity did not predict change in measures of physical function. CONCLUSIONS Walking confidence of adults discharged from rehabilitation services after hip fracture had a greater association with short-term recovery of physical function than level of physical activity. Community-dwelling adults continue to make small short-term improvements in physical function and walking confidence after discharge home and withdrawal of rehabilitation services.
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Affiliation(s)
- Nicholas F Taylor
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Casey L Peiris
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anne L Thompson
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Luke A Prendergast
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Katherine E Harding
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedics, Eastern Health, Box Hill, Victoria, Australia
| | - Nora Shields
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
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19
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Fitzgerald A, Verrall C, Henderson J, Willis E. Factors influencing missed nursing care for older people following fragility hip fracture. Collegian 2020. [DOI: 10.1016/j.colegn.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Zusman EZ, Dawes M, Fleig L, McAllister MM, Cook WL, Guy P, Brasher PMA, McKay HA, Khan KM, Ashe MC. Older Adults' Sedentary Behavior and Physical Activity After Hip Fracture: Results From an Outpatient Rehabilitation Randomized Controlled Trial. J Geriatr Phys Ther 2020; 42:E32-E38. [PMID: 30028352 DOI: 10.1519/jpt.0000000000000193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Prolonged sedentary time and limited physical activity can result in deleterious effects on health and mobility, especially for older adults with fall-related hip fracture. Therefore, the purpose of this study was to examine the effect of a multidisciplinary clinic on sedentary behavior and physical activity (prespecified secondary outcomes) and provide descriptions of activity patterns over 1 year for men and women. METHODS We conducted a parallel-group, single-blinded randomized controlled trial comparing a multidisciplinary clinic and usual care (intervention) with usual care (control). We recruited 53 community-dwelling older adults aged 65+ years who were 3 to 12 months postfracture and collected data at baseline, 6, and 12 months; study staff were blinded to group allocation. The clinic included a geriatric assessment by the geriatrician, physiotherapist, and occupational therapist. Referrals were made to other professionals, when indicated. We collected the accelerometer-measured sedentary behavior and physical activity at 3 time points. We used linear mixed-effects models to compare groups at 6 and 12 months and mixed models to compare outcomes between men and women. RESULTS Participants were sedentary for more than 10 hours of a 13-hour day, and there were no significant differences between the study groups at 6 months (2.4 [95% confidence interval: -22.4 to 27.2] minutes) or 12 months (-3.7 [95% confidence interval: -33.6 to 26.1] minutes). Compared with women, men spent 47.2 min/d more in sedentary time (P = .052) and 43.8 min/d less in light physical activity (P = .047). DISCUSSION Older adults after hip fracture spend prolonged periods of waking hours sedentary with very little activity.
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Affiliation(s)
- Enav Z Zusman
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Martin Dawes
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Lena Fleig
- Health Psychology/Social, Organizational and Economic Psychology, Freie Universität Berlin, Berlin, Germany
| | - Megan M McAllister
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Wendy L Cook
- Division of Geriatric Medicine, Department of Medicine, The University of British Columbia, Vancouver, Canada.,Providence Healthcare, Toronto, Ontario, Canada
| | - Pierre Guy
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada.,School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, Canada.,Department of Family Practice, The University of British Columbia, Vancouver, Canada
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21
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Kozica-Olenski S, McRae P, Bew P, Mudge A. 'I will walk out of here': Qualitative analysis of older rehabilitation patients' perceptions of mobility. Australas J Ageing 2020; 39:209-216. [PMID: 32096895 DOI: 10.1111/ajag.12777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To understand the motivation of older rehabilitation inpatients for mobilisation, and identify barriers and enablers to greater mobilisation. METHODS Qualitative semi-structured interviews were conducted with older rehabilitation inpatients. All interviews were audio-taped, transcribed verbatim and analysed using thematic and inductive techniques. RESULTS From 23 interviews, we found that older patients strongly value mobilisation during rehabilitation admission, to get better and maintain identity, personhood and meaningful connections. At the patient level, mobilisation was impacted by patient's confidence, family support and symptom management. At the organisational level, barriers to mobilisation included lack of timely staff support, inflexible routines, limited social opportunities, lack of physical resources, and poor communication. CONCLUSIONS Recognising and understanding motivators, enablers and barriers to mobilising during subacute hospitalisation of older patients is an essential step towards developing and implementing successful strategies to promote greater mobilisation. Addressing mobilisation barriers requires a multifaceted approach at the patient and organisational level.
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Affiliation(s)
- Samantha Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Paul Bew
- Brighton Health Campus, Brighton, Qld, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
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Bland MD, Barco P, Lang CE, Lenard E, Kallmi S, Pennock S, Lenze EJ. Activity Level and Intensity of Older Adults in Skilled Nursing Rehabilitation Measured via Actigraphy. J Geriatr Phys Ther 2020; 44:45-50. [DOI: 10.1519/jpt.0000000000000259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Lenze EJ, Lenard E, Bland M, Barco P, Miller JP, Yingling M, Lang CE, Morrow-Howell N, Baum CM, Binder EF, Rodebaugh TL. Effect of Enhanced Medical Rehabilitation on Functional Recovery in Older Adults Receiving Skilled Nursing Care After Acute Rehabilitation: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e198199. [PMID: 31365113 PMCID: PMC6669784 DOI: 10.1001/jamanetworkopen.2019.8199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Enhanced medical rehabilitation (EMR) is a systematic and standardized approach for physical and occupational therapists to engage patients. Higher patient engagement in therapy might lead to improved functional recovery in rehabilitation settings, such as skilled nursing facilities (SNFs). OBJECTIVE To determine whether EMR improves older adults' functional recovery. DESIGN, SETTING, AND PARTICIPANTS A double-blind, parallel-group, randomized clinical trial was conducted from July 29, 2014, to July 13, 2018, in 229 adults aged 65 years or older admitted to 2 US SNFs. Participants were randomized to receive EMR (n = 114) vs standard-of-care rehabilitation (n = 115). Intention-to-treat analysis was used. INTERVENTIONS The intervention group received their physical and occupational therapy from therapists trained in EMR. Based on models of motivation and behavior change, EMR is a toolkit of techniques to increase patient engagement and therapy intensity. The control group received standard-of-care rehabilitation from physical and occupational therapists not trained in EMR. MAIN OUTCOMES AND MEASURES The primary outcome was change in function in activities of daily living and mobility, as assessed with the Barthel Index, which measures 10 basic activities of daily living or mobility items (scale range, 0-100), from SNF admission to discharge; secondary outcomes were gait speed for 10 m, 6-minute walk test, discharge disposition, rehospitalizations, and self-reported functional status at days 30, 60, and 90. To examine the rehabilitation process, therapists' engagement with patients and patient active time during therapy were measured for a sample of the sessions. RESULTS Of the 229 participants, 149 (65.1%) were women; 177 (77.3%) were white, and 51 (22.3%) were black; mean (SD) age was 79.3 (8.0) years. Participants assigned to EMR showed greater recovery of function than those assigned to standard of care (mean increase in Barthel Index score, 35 points; 95% CI, 31.6-38.3 vs 28 points; 95% CI, 25.2-31.7 points; P = .007). There was no evidence of a difference in the length of stay (mean [SD], 23.5 [13.1] days). However, there were no group by time differences in secondary outcome measures, including self-reported function after SNF discharge out to 90 days as measured on the Barthel Index (mean [SE] score: EMR, 83.65 [2.20]; standard of care, 84.67 [2.16]; P = .96). The EMR therapists used a median (interquartile range) of 24.4 (21.0-37.3) motivational messages per therapy session vs 2.3 (1.1-2.9) for nontrained therapists (P < .001), and EMR patients were active during a mean (SD) of 52.5 (6.6%) of the therapy session time vs 41.2 (6.8%) for nontrained therapists (P = .001). CONCLUSIONS AND RELEVANCE Enhanced medical rehabilitation modestly improved short-term functional recovery for selected older adults rehabilitating in SNFs. However, there was no evidence that the benefits persisted over the longer term. This study demonstrates the value of engaging and motivating older adults in rehabilitation therapy, but more work is needed to extend these benefits to longer-term outcomes after discharge home. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02114879.
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Affiliation(s)
- Eric J. Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emily Lenard
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marghuretta Bland
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Peggy Barco
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - J. Philip Miller
- Division of Biostatistics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
- Division of Biostatistics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nancy Morrow-Howell
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Carolyn M. Baum
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ellen F. Binder
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Thomas L. Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
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Park YH, Kim W, Park JH, Kim HJ. Impact of metabolic syndrome on patient outcomes of supination-external rotation ankle fracture. Injury 2019; 50:1388-1391. [PMID: 31176479 DOI: 10.1016/j.injury.2019.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Abstract
Metabolic syndrome has been known as a risk factor for morbidity following orthopedic procedures, yet its impact on surgical treatment of ankle fractures remains unclear. The aim of this study was to compare the patient outcomes of surgical treatment of supination-external rotation ankle fractures in patients with and without metabolic syndrome. This study was designed as a retrospective matched case-control study. Forty-nine patients with supination-external rotation ankle fracture and metabolic syndrome were age-, sex-, and fracture type-matched with 49 controls without metabolic syndrome. Olerud-Molander Ankle Score (OMAS), Visual Analog Scale (VAS), Kellgren and Lawrence (K&L) scale, and complications were assessed at final follow-up. The mean postoperative follow-up was 19.5 months (range, 13-44). The OMAS measurements in the metabolic syndrome group were lower than those in the control group (p = 0.006) and the VAS for pain measurements in the metabolic syndrome group were greater than those in the control group (p < 0.001). The K&L scale and complications did not differ significantly between the two groups. Patients with metabolic syndrome are at risk for higher pain scores and lower functional outcomes after surgical treatment for supination-external rotation ankle fracture. These results suggest that metabolic syndrome should be treated together with ankle fractures.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
| | - Woon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
| | - Ji Hun Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
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Effects of dynamic loading on fracture healing under different locking compression plate configurations: A finite element study. J Mech Behav Biomed Mater 2019; 94:74-85. [DOI: 10.1016/j.jmbbm.2019.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 12/30/2022]
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Orwig D, Hochberg MC, Gruber-Baldini AL, Resnick B, Miller RR, Hicks GE, Cappola AR, Shardell M, Sterling R, Hebel JR, Johnson R, Magaziner J. Examining Differences in Recovery Outcomes between Male and Female Hip Fracture Patients: Design and Baseline Results of a Prospective Cohort Study from the Baltimore Hip Studies. J Frailty Aging 2019; 7:162-169. [PMID: 30095146 DOI: 10.14283/jfa.2018.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Incidence of hip fractures in men is expected to increase, yet little is known about consequences of hip fracture in men compared to women. It is important to investigate differences at time of fracture using the newest technologies and methodology regarding metabolic, physiologic, neuromuscular, functional, and clinical outcomes, with attention to design issues for recruiting frail older adults across numerous settings. OBJECTIVES To determine whether at least moderately-sized sex differences exist across several key outcomes after a hip fracture. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study (Baltimore Hip Studies 7th cohort [BHS-7]) was designed to include equal numbers of male and female hip fracture patients to assess sex differences across various outcomes post-hip fracture. Participants were recruited from eight hospitals in the Baltimore metropolitan area within 15 days of admission and were assessed at baseline, 2, 6 and 12 months post-admission. MEASUREMENTS Assessments included questionnaire, functional performance evaluation, cognitive testing, measures of body composition, and phlebotomy. RESULTS Of 1709 hip fracture patients screened from May 2006 through June 2011, 917 (54%) were eligible and 39% (n=362) provided informed consent. The final analytic sample was 339 (168 men and 171 women). At time of fracture, men were sicker (mean Charlson score= 2.4 vs. 1.6; p<0.001) and had worse cognition (3MS score= 82.3 vs. 86.2; p<0.05), and prior to fracture were less likely to be on bisphosphonates (8% vs. 39%; p<0.001) and less physically active (2426 kilocalories/week vs. 3625; p<0.001). CONCLUSIONS This paper provides the study design and methodology for recruiting and assessing hip fracture patients and evidence of baseline and pre-injury sex differences which may affect eventual recovery one year later.
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Affiliation(s)
- D Orwig
- Denise L. Orwig, PhD, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, Tel: 410-706-8951; Fax 410-706-4433;
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Ariza-Vega P, Shu H, Amarasekera R, Y. Edwards N, Filipski M, Langford D, Madden K, C. Ashe M. Older adults’ activity on a geriatric hospital unit: A behavioral mapping study. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dorsch S, Weeks K, King L, Polman E. In inpatient rehabilitation, large amounts of practice can occur safely without direct therapist supervision: an observational study. J Physiother 2019; 65:23-27. [PMID: 30573440 DOI: 10.1016/j.jphys.2018.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
QUESTIONS When a hospital gymnasium used for inpatient rehabilitation is set up to allow semi-supervised practice: what percentage of practice is performed as semi-supervised practice, what percentage of patients in the gym are actively engaged in practice at one time, and is the semi-supervised practice that occurs safe? DESIGN An observational study using periodic behaviour mapping. PARTICIPANTS Patients in general and stroke rehabilitation units of a metropolitan hospital. OUTCOME MEASURES Observations in the rehabilitation gym quantified the number of patients in the gym and the numbers of patients practising and resting. In observations of patients practising, the condition of practice was recorded as being with a therapist, with a family member, or with no direct supervision. The number of adverse events during the data collection period was collected from the hospital Incident Information Management System. RESULTS The rehabilitation gym was observed on 113 occasions, resulting in 1319 individual patient observations. An average of 12 patients were in the gym during the observations. Practice was being performed with family supervision in 15% of observations and with no direct supervision in 26% of observations, resulting in semi-supervised practice accounting for 41% of all observations of practice. The percentage of observations that were of patients taking part in active practice was 78%. There were no adverse events in the gym. CONCLUSION In an inpatient setting, a large percentage of practice can be performed as semi-supervised practice. This does not appear to compromise the time spent in active practice or patient safety.
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Affiliation(s)
- Simone Dorsch
- School of Allied Health, Australian Catholic University, Sydney, Australia; StrokeEd Collaboration, Sydney, Australia.
| | - Kevin Weeks
- Brindabella Rehabilitation Service, University of Canberra Hospital, ACT Health, Canberra, Australia
| | - Laura King
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Etesa Polman
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
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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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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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Lenze EJ, Barco PP, Bland MD. Depression and Functional Impairment: A Pernicious Pairing in Older Adults. Am J Geriatr Psychiatry 2018; 26:73-74. [PMID: 29107459 DOI: 10.1016/j.jagp.2017.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University, St Louis, MO.
| | - Peggy P Barco
- Department of Psychiatry, Washington University, St Louis, MO
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32
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Physical Activity and Sedentary Behavior Subsequent to Serious Orthopedic Injury: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2017.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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33
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Zusman EZ, Dawes MG, Edwards N, Ashe MC. A systematic review of evidence for older adults' sedentary behavior and physical activity after hip fracture. Clin Rehabil 2017; 32:679-691. [PMID: 29169245 DOI: 10.1177/0269215517741665] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesize evidence on older adults' sedentary behavior and physical activity during rehabilitation and recovery for hip fracture (1) across the care continuum and (2) from clinical interventions. DESIGN We conducted a systematic review of peer-reviewed publications using CINAHL, Embase, Ovid MEDLINE, PsycINFO, and SportDiscus (last search: 17 October 2017). STUDY SELECTION We included studies that measured sedentary behavior and physical activity of older adults with hip fracture using activity monitors (e.g. accelerometers). We identified literature at Level 1 (title and abstract) and Level 2 (full text), and conducted forward and backward searches. We assessed observational studies' adherence to reporting guidelines and intervention studies' risk of bias. RESULTS We included 14 studies (882 participants). Four studies reported sedentary behavior data, while all studies reported information on physical activity. Settings included hospital, rehabilitation centers, and the community. Nine studies were observational; five were experimental design. Older adults had excessive sedentary time (>10 hours/day) and low physical activity. Participants' average upright time differed across settings. During hospital stay, it ranged 16-52 minutes/day, while in the community, it ranged 51-261 minutes/day. Data from five interventions reported on physical activity change: two studies increased between 14 and 27 minutes/day. Another study reported participants accumulated 6994 steps/day at the end of the intervention, but for two other interventions, activity was below 5000 steps/day. CONCLUSION Based on available evidence, older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery.
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Affiliation(s)
- Enav Z Zusman
- 1 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada.,2 Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | - Martin G Dawes
- 2 Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | - Nicola Edwards
- 1 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
| | - Maureen C Ashe
- 1 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada.,2 Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
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Turunen K, Aaltonen L, Kumpumäki J, Portegijs E, Keikkala S, Kinnunen ML, Finni T, Sipilä S, Nikander R. A tailored counseling and home-based rehabilitation program to increase physical activity and improve mobility among community-dwelling older people after hospitalization: protocol of a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:477. [PMID: 29162078 PMCID: PMC5697209 DOI: 10.1186/s12891-017-1825-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Physical activity (PA) decreases during hospitalization. In particular, the amount of PA engaged in by older people who are hospitalized following musculoskeletal injury is likely to be limited for months after discharge home. Given the importance of an active lifestyle for their recovery and the prevention of future adverse outcomes, there is clearly a need for interventions to increase PA. This article describes the protocol of a randomized controlled trial set up to investigate the effects of a physical activity oriented home rehabilitation program (ProPA) on PA and the restoration of mobility in community-dwelling older people. METHODS Men and women aged 60 years or older hospitalized due to a musculoskeletal injury or disorder in the back or lower limbs are recruited. After discharge from hospital to home, participants are randomized into a six-month ProPA program or a standard care (control) group. The ProPA program consists of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program and physical activity counseling. In addition, frail participants who are not able to go outdoors alone receive support from volunteers. Primary outcomes are PA measured using a 3-dimentional accelerometer, and mobility assessed by the Short Physical Performance Battery and self-reports. Secondary outcomes are life space mobility, participation restriction, fear of falling, pain, mood, and grip strength. Information on barriers to and enablers of PA participation are also collected. Data on mortality and use of health services are collected from the national register. In this 6-month intervention, all participants are assessed in their homes at baseline and after three and six months, and at 12 months after randomization they will receive a follow-up questionnaire. DISCUSSION This study investigates the effects of a rehabilitation program on PA and mobility among older people at risk for increased sedentary time and mobility problems. If positive effects are observed, the program can be considered for incorporation into the health care system and thereby contribute to the rehabilitation of older people who have recently been discharged from hospital. TRIAL REGISTRATION ISRCTN13461584 . Registered 27 January 2016.
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Affiliation(s)
- K. Turunen
- GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
| | - L. Aaltonen
- GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
| | - J. Kumpumäki
- GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
| | - E. Portegijs
- Gerontology Research Center and Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - S. Keikkala
- Health Centre Hospital, Health Centre of Jyväskylä Cooperation Area, City of Jyväskylä, Finland
| | - M.-L. Kinnunen
- Health Centre Hospital, Health Centre of Jyväskylä Cooperation Area, City of Jyväskylä, Finland
| | - T. Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - S. Sipilä
- Gerontology Research Center and Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R. Nikander
- GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
- Gerontology Research Center and Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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The association between patient participation and functional gain following inpatient rehabilitation. Aging Clin Exp Res 2017; 29:729-736. [PMID: 27590904 DOI: 10.1007/s40520-016-0625-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. METHODS All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. RESULT A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). CONCLUSION This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.
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Peiris C, Shields N, Kingsley M, Yeung J, Hau R, Taylor N. Maximum Tolerated Dose of Walking for Community-Dwelling People Recovering From Hip Fracture: A Dose-Response Trial. Arch Phys Med Rehabil 2017; 98:2533-2539. [PMID: 28465223 DOI: 10.1016/j.apmr.2017.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine how much moderate-intensity physical activity, in the form of walking, could be prescribed for people living in the community after hip fracture in terms of safety, tolerability, and feasibility. DESIGN Phase I dose-response design. SETTING Public community rehabilitation centers. PARTICIPANTS Community-dwelling adults (N=21; 16 women; mean age, 75±9y) who were cognitively alert, attending community rehabilitation after hip fracture (mean days postfracture, 110±47d), able to walk with or without a gait aid, and for whom it was safe to participate in physical activity. INTERVENTIONS Individually supervised doses of moderate-intensity walking completed in 1 week in addition to their usual levels of physical activity. Three participants were required to complete a dose of walking before dose escalation for the next cohort of 3 participants. Dose escalation ceased when >1 participant in a cohort had an adverse event or was unable to tolerate the dose or if the maximum dose of 150min/wk was achieved. MAIN OUTCOME MEASURES Maximum tolerated dose of walking per week (in minutes), adverse events, mobility, and walking confidence. RESULTS The maximum tolerated dose of walking for adults after hip fracture before significant discomfort was experienced (eg, breathlessness, pain, and fatigue) by any participant was 100min/wk. No adverse events occurred, but participants began to be unable to tolerate higher doses beyond 100min/wk. CONCLUSIONS This provides preliminary evidence that community-dwelling older adults recovering from hip fracture can complete a sufficient amount of moderate-intensity physical activity to maintain and improve their health.
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Affiliation(s)
- Casey Peiris
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia; Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia.
| | - Nora Shields
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia; Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia
| | - Michael Kingsley
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Jack Yeung
- Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia
| | - Raphael Hau
- Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia; Northern Clinical School, University of Melbourne, Epping, Victoria, Australia
| | - Nicholas Taylor
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia; Eastern Health, Eastern Health Clinical Research Office, Box Hill, Victoria, Australia
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Computational modelling of bone fracture healing under partial weight-bearing exercise. Med Eng Phys 2017; 42:65-72. [DOI: 10.1016/j.medengphy.2017.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 11/21/2022]
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Suwanpasu S, Aungsuroch Y, Jitapanya C. Post-surgical physical activity enhancing program for elderly patients after hip fracture: a randomized controlled trial. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0804.323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background: Hip fracture seriously influences an elderly person’s life and mobility, independent living, and causes earlier mortality. Although surgery is generally successful, many of the elderly suffer from decreased physical ability after surgery for hip fracture.
Objectives: To determine the effects of a physical activity enhancing program (PEP) on the level of physical activity of elderly patients after surgical treatment of hip fracture.
Methods: A randomized controlled trial of 46 elderly patients was conducted at King Chulalongkorn Memorial Hospital from January 2012 to February 2013 to evaluate the effectiveness of the Resnick self-efficacy model (2009) compared with standard care in improving physical activity. The participants were enrolled on a criteria basis and were block randomized into two groups. The intervention group attended four phases of physical training and efficacy based intervention comprising assessment, preparation, practicing, and evaluation phases with face-to-face contact and five telephone calls during seven weeks post-surgery.
Results: Six weeks after discharge, the physical activity of the intervention group increased by significantly more than the control group (F1,43 = 9.63, P < 0.01), with an effect size of 0.18 after controlling for preoperative physical activity. The ratio of the effect on physical activity induced by the PEP was higher than that induced by usual care (65.2% vs. 47.8%).
Conclusion: PEP is effective at improving physical activity. Efforts to follow up for longer periods and with studies using larger populations are recommended.
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Affiliation(s)
- Sunee Suwanpasu
- Nursing Department, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Yupin Aungsuroch
- Yupin Aungsuroch, Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand
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Turunen K, Salpakoski A, Edgren J, Törmäkangas T, Arkela M, Kallinen M, Pesola M, Hartikainen S, Nikander R, Sipilä S. Physical Activity After a Hip Fracture: Effect of a Multicomponent Home-Based Rehabilitation Program-A Secondary Analysis of a Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:981-988. [PMID: 28137475 DOI: 10.1016/j.apmr.2017.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the effect of a yearlong multicomponent rehabilitation program on the level of physical activity (PA) and the maintenance of the level of PA over 1-year follow-up among older people recovering from a recent hip fracture. DESIGN Secondary analysis of a randomized, controlled, parallel-group trial. SETTING Home-based rehabilitation; measurements in university laboratory. PARTICIPANTS Community-dwelling people (N=81) aged ≥60 years recovering from a hip fracture. Participants were randomly assigned to an intervention (n=40) or a control (n=41) group, on average, 42±23 days after discharge from the hospital. INTERVENTION A yearlong intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacologic pain management, a progressive home exercise program, PA counseling, and standard care. MAIN OUTCOME MEASURES The outcome was the level of PA, which was assessed with the questionnaire (a modified Grimby scale) at baseline, and 3, 6, 12, and 24 months after baseline. Three PA categories were defined: inactivity, light PA, and moderate to heavy PA. Physical function was assessed using the Short Physical Performance Battery (SPPB) at baseline. The effects of the intervention were analyzed with generalized estimating equations. RESULTS In the intervention group, a significant increase was observed in the level of PA after the intervention (interaction P=.005) and after 1-year follow-up (P=.021) compared with the standard care only. The benefit was particularly evident among the participants with a baseline SPPB score of ≥7 (interaction P<.001). CONCLUSIONS The 12-month individualized multicomponent rehabilitation program increased PA among older patients with hip fracture. The increase was found to be maintained at the 1-year follow-up.
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Affiliation(s)
- Katri Turunen
- Gerontogy Research Center, Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland; GeroCenter Foundation for Aging Research and Development, Jyvaskyla, Finland.
| | - Anu Salpakoski
- Research and Development, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
| | - Johanna Edgren
- Gerontogy Research Center, Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Timo Törmäkangas
- Gerontogy Research Center, Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Marja Arkela
- Department of Physiotherapy, Central Hospital of Central Finland, Jyvaskyla, Finland
| | - Mauri Kallinen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland; Center for Life Course Epidemiology Research, University of Oulu, Oulu, Finland
| | - Maija Pesola
- Department of Orthopedics and Traumatology, Central Hospital of Central Finland, Jyvaskyla, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Riku Nikander
- Gerontogy Research Center, Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland; GeroCenter Foundation for Aging Research and Development, Jyvaskyla, Finland; Research & Education, Central Hospital of Central Finland, Jyvaskyla, Finland
| | - Sarianna Sipilä
- Gerontogy Research Center, Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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Latshang TD, Mueller DJ, Lo Cascio CM, Stöwhas AC, Stadelmann K, Tesler N, Achermann P, Huber R, Kohler M, Bloch KE. Actigraphy of Wrist and Ankle for Measuring Sleep Duration in Altitude Travelers. High Alt Med Biol 2016; 17:194-202. [PMID: 27383065 DOI: 10.1089/ham.2016.0006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Latshang, Tsogyal Daniela, Daniela Juliana Mueller, Christian Maurizio Lo Cascio, Anne-Christin Stöwhas, Katrin Stadelmann, Noemi Tesler, Peter Achermann, Reto Huber, Malcolm Kohler, and Konrad Ernst Bloch. Actigraphy of wrist and ankle for measuring sleep duration in altitude travelers. High Alt Med Biol. 17:194-202, 2016-Aims: Actigraphy might be convenient to assess sleep disturbances in altitude field studies. Therefore, we evaluated whether actigraphy accurately measures sleep duration in healthy subjects traveling to altitude. METHODS Fifty-one healthy men, aged mean ± standard deviation (SD) 27 ± 9 years, were studied during one night at Zurich (490 m), two nights at Davos Wolfgang (1630 m), and two nights at Jakobshorn (2590 m), in randomized order. Sleep duration measured by actigraphy, using a one-axis device at the wrist (n = 51), a three-axis device at the other wrist, and a three-axis device at the ankle (n = 22), was compared with corresponding total sleep time (TST) measured by polysomnography. RESULTS During 255 polysomnographic overnight studies, 449 paired actigraphic recordings were obtained. The median polysomnographic-derived TST ranged from 397 to 408 minutes. Actigraphic mean TST from wrists with one-axis and three-axis devices, and from ankle agreed well with polysomnographic values with a bias of +1, -7, +6 minutes, respectively. Corresponding limits of agreement (±2 SD of bias) were ±51, ±60, and ±59 minutes. Limits of agreement of mean TST over five nights by actigraphy and polysomnography were similar to the coefficient of repeatability (2 SD of mean) of polysomnographic TST, that is, ±31, ±38, and ±36 minutes versus ±34 minutes. CONCLUSIONS Actigraphy of the wrist or ankle by a one-axis or a three-axis device accurately estimates mean TST in groups of subjects and mean TST over several nights in individuals traveling to altitude. Therefore, actigraphy is valuable for assessing effects of altitude and other environmental influences on sleep duration during field studies over extended periods.
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Affiliation(s)
- Tsogyal Daniela Latshang
- 1 Pulmonary Division, Sleep Disorders Center, University Hospital of Zurich , Zurich, Switzerland .,2 Zurich Center for Interdisciplinary Sleep Research, University of Zurich , Zurich, Switzerland
| | - Daniela Juliana Mueller
- 1 Pulmonary Division, Sleep Disorders Center, University Hospital of Zurich , Zurich, Switzerland
| | | | - Anne-Christin Stöwhas
- 1 Pulmonary Division, Sleep Disorders Center, University Hospital of Zurich , Zurich, Switzerland
| | - Katrin Stadelmann
- 3 Institute of Pharmacology and Toxicology, University of Zurich , Zurich, Switzerland
| | - Noemi Tesler
- 4 Child Development Center and Pediatric Sleep Disorders Center, University Children's Hospital , Zurich, Zurich, Switzerland
| | - Peter Achermann
- 2 Zurich Center for Interdisciplinary Sleep Research, University of Zurich , Zurich, Switzerland .,3 Institute of Pharmacology and Toxicology, University of Zurich , Zurich, Switzerland .,5 Zurich Center for Integrative Human Physiology, University of Zurich , Zurich, Switzerland
| | - Reto Huber
- 2 Zurich Center for Interdisciplinary Sleep Research, University of Zurich , Zurich, Switzerland .,4 Child Development Center and Pediatric Sleep Disorders Center, University Children's Hospital , Zurich, Zurich, Switzerland .,5 Zurich Center for Integrative Human Physiology, University of Zurich , Zurich, Switzerland
| | - Malcolm Kohler
- 1 Pulmonary Division, Sleep Disorders Center, University Hospital of Zurich , Zurich, Switzerland .,2 Zurich Center for Interdisciplinary Sleep Research, University of Zurich , Zurich, Switzerland .,5 Zurich Center for Integrative Human Physiology, University of Zurich , Zurich, Switzerland
| | - Konrad Ernst Bloch
- 1 Pulmonary Division, Sleep Disorders Center, University Hospital of Zurich , Zurich, Switzerland .,2 Zurich Center for Interdisciplinary Sleep Research, University of Zurich , Zurich, Switzerland .,5 Zurich Center for Integrative Human Physiology, University of Zurich , Zurich, Switzerland
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Trammell M, Kapoor P, Swank C, Driver S. Improving practice with integration of patient directed activity during inpatient rehabilitation. Clin Rehabil 2016; 31:3-10. [PMID: 26837432 DOI: 10.1177/0269215515625100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early initiation of rehabilitation following stroke promotes better long-term outcomes than delayed onset, emphasizing the importance of inpatient therapy. However, literature indicates that following stroke individuals in inpatient rehabilitation spend the majority of their day in their bedroom and inactive. Consequently, since amount of functional activity is posited to relate to outcomes, the current rehabilitation model needs to be challenged with innovative solutions to maximize recovery. RATIONALE In an attempt to promote greater activity and higher doses of therapy during inpatient rehabilitation, we implemented the "Patient Directed Activity Program" to facilitate specific movement and improve outcomes for patients post stroke. Our interdisciplinary activity program was conceptualized on a theoretical model for stroke recovery and principles of experience-dependent neural plasticity. MAIN FEATURES The "Patient Directed Activity Program" includes distinct activity stations designed to increase repetition, stimulation, attention, and activity of the affected upper extremities, lower extremities, and trunk. Each task-specific activity was easily graded to achieve moderate- to high-intensity. The activity program prescribed individuals up to three additional 30-minute bouts of activities daily that were to be completed independently, and in addition to standard of care. Clinical application: After implementing this program in our facility for one year as a quality improvement project, the intervention has been delivered as an Institutional Review Board approved randomized controlled trial (Clinical Trial #NCT02446197). Challenges with people and facilities have been overcome, resulting in a feasible program that can be delivered in an inpatient setting. High satisfaction has been reported by patients and clinicians.
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Affiliation(s)
- Molly Trammell
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA
| | - Priyanka Kapoor
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA
| | - Chad Swank
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA.,2 Department of Physical Therapy, Texas Woman's University, TX, USA
| | - Simon Driver
- 1 Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX, USA
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Rettke H, Geschwindner HM, van den Heuvel WJA. Assessment of Patient Participation in Physical Rehabilitation Activities: An Integrative Review. Rehabil Nurs 2015; 40:209-23. [DOI: 10.1002/rnj.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2014] [Indexed: 11/12/2022]
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Lyons EJ, Lewis ZH, Mayrsohn BG, Rowland JL. Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis. J Med Internet Res 2014; 16:e192. [PMID: 25131661 PMCID: PMC4147713 DOI: 10.2196/jmir.3469] [Citation(s) in RCA: 319] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 12/17/2022] Open
Abstract
Background Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. Objective The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. Methods Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. Results All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. Conclusions Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings.
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Affiliation(s)
- Elizabeth J Lyons
- The University of Texas Medical Branch, Institute for Translational Sciences, Galveston, TX, United States.
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Host HH, Lang CE, Hildebrand MW, Zou D, Binder EF, Baum CM, Freedland KE, Morrow-Howell N, Lenze EJ. Patient Active Time During Therapy Sessions in Postacute Rehabilitation: Development and Validation of a New Measure. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2014; 32:169-178. [PMID: 25419032 DOI: 10.3109/02703181.2014.915282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE The accurate measurement of therapy intensity in postacute rehabilitation is important for research to improve outcomes in this setting. We developed and validated a measure of Patient Active Time during physical (PT) and occupational therapy (OT) sessions, as a proxy for therapy intensity. METHODS This measurement validity study was carried out with 26 older adults admitted to a skilled nursing facility (SNF) for postacute rehabilitation with a variety of main underlying diagnoses, including hip fracture, cardiovascular diseases, stroke, and others. They were participants in a randomized controlled trial that compared an experimental high-intensity therapy to standard-of-care therapy. Patient Active Time was observed by research raters as the total number of minutes that a patient was actively engaging in therapeutic activities during PT and OT sessions. This was compared to patient movement (actigraphy) quantified during some of the same PT/OT sessions using data from three-dimensional accelerometers worn on the patient's extremities. RESULTS Activity measures were collected for 136 therapy sessions. Patient Active Time had high interrater reliability in both PT (r = 0.995, p < 0.001) and OT (r = 0.95, p = 0.012). Active time was significantly correlated with actigraphy in both PT (r = 0.73, p < 0.001) and OT (r = 0.60, p < 0.001) and discriminated between a high-intensity experimental condition and standard of care rehabilitation: in PT, 47.0 ± 13.5 min versus 16.7 ± 10.1 min (p < 0.001) and in OT, 46.2 ± 15.2 versus 27.7 ± 6.6 min (p < 0.001). CONCLUSIONS Systematic observation of Patient Active Time provides an objective, reliable, and valid index of physical activity during PT and OT treatment sessions that has utility as a real-world alternative to the measurement of treatment intensity. This measure could be used to differentiate higher from lower therapy treatment intensity and to help determine the optimal level of active therapy time for patients in postacute and other settings.
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Affiliation(s)
- Helen H Host
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Catherine E Lang
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary W Hildebrand
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dequan Zou
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ellen F Binder
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carolyn M Baum
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth E Freedland
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nancy Morrow-Howell
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric J Lenze
- Program in Physical Therapy, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Torres J, Gutierres M, Lopes MA, Santos JD, Cabral AT, Pinto R, van Eck C. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. BIOMED RESEARCH INTERNATIONAL 2014; 2014:451781. [PMID: 24955356 PMCID: PMC4052697 DOI: 10.1155/2014/451781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. MATERIAL AND METHODS 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B). RESULTS There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P < 0.05). DISCUSSION These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. CONCLUSION Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.
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Affiliation(s)
- Joao Torres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M. Ascenção Lopes
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal
| | - J. Domingos Santos
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal
| | - A. T. Cabral
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - R. Pinto
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carola van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufman building suite 1011, Pittsburgh, PA 15213, USA
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Hershkovitz A, Brown R, Burstin A, Brill S. Measuring rehabilitation outcome in post-acute hip fractured patients. Disabil Rehabil 2014; 37:158-64. [DOI: 10.3109/09638288.2014.911968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Denkinger MD, Flick SE, Nikolaus T, Becker C, Aminian K, Lindemann U. Assessing physical activity in inpatient rehabilitation—sensor-based validation of the PAIR. Eur Rev Aging Phys Act 2014. [DOI: 10.1007/s11556-014-0137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
BACKGROUND Hip fracture is a serious health problem among older adults and often results in serious consequences such as disabilities. Informal caregivers (CGs) are particularly important for the successful recovery of older adult patients with hip fractures while they undergo surgical procedures and extensive rehabilitation therapies. In a previous study, we developed a comprehensive theory-based online hip fracture resource center for CGs and conducted a feasibility study. The 8-week online hip fracture resource center, including learning modules, moderated-discussion boards (DB), Ask-the-Experts, and virtual libraries, was used by CGs. PURPOSE This study reports findings from a qualitative analysis of DB postings. METHODS The data were analyzed using content analysis in conjunction with an inductive coding approach. The analyses yielded 6 themes and 3 categories related to hip fracture care (e.g., specific types of care provided by CGs). RESULTS/CONCLUSION Findings suggest that DB forums can serve as a medium for CGs to share their experiences and to obtain support. Furthermore, DB forums can assist healthcare providers in identifying further opportunities to assist CGs. The study is limited to a small sample size in one hospital. Further studies are needed with larger samples in diverse settings.
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Sylliaas H, Wyller TB, Bergland A. Progressive Strength Training Based upon the Principle of Overloading for a 86-Year-Old Hip Fracture Patient. A Case Report. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2013. [DOI: 10.3109/02703181.2013.809399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Effects of a rehabilitation program on perceived environmental barriers in older patients recovering from hip fracture: a randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2013; 2013:769645. [PMID: 23986910 PMCID: PMC3748419 DOI: 10.1155/2013/769645] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/05/2013] [Accepted: 07/15/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To study effects of a one-year multicomponent intervention on perceived environmental barriers in hip fracture patients. DESIGN Randomized controlled trial of a 12-month home-based rehabilitation aiming to improve mobility and function (ISRCTN53680197); secondary analyses. Subjects. Community-dwelling hip fracture patients on average 70 days after trauma (n = 81). METHODS Assessments at baseline, 3, 6, and 12 months later included perceived entrance-related barriers (e.g., indoor/outdoor stairs, lighting, floor surfaces, and storage for mobility devices) and perceived barriers in the outdoor environment (poor street condition, hilly terrain, long-distances, and lack of resting places). Sum scores for entrance-related and outdoor barriers were analyzed using general estimating equation models. RESULTS At baseline, 48% and 37% of the patients perceived at least one entrance-related barrier, and 62% and 60% perceived at least one outdoor barrier in the intervention and control group, respectively. Over time, (P = 0.003) the number of entrance-related barriers decreased in both groups (group P = 0.395; interaction P = 0.571). For outdoor barriers, time (P = 0.199), group (P = 0.911), and interaction effect (P = 0.430) were not significant. CONCLUSION Our intervention had no additional benefit over standard care in hip fracture patients. Further study is warranted to determine whether perceived environmental barriers can be reduced by interventions targeted at the older individual. This trial is registered with ISRCTN53680197.
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