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Lewandowski DA, Badurudeen A, Matthews T. The Impact of Concomitant Neck of Femur Fractures and Upper Limb Fractures on Length of Stay and Key Performance Indicators: A Single-Centre Study. Cureus 2024; 16:e60862. [PMID: 38910742 PMCID: PMC11192213 DOI: 10.7759/cureus.60862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Background Hip fractures are one of the most common serious injuries seen today and constitute one of the most serious healthcare problems affecting the elderly worldwide. Due to the elderly population, associated falls and osteoporosis increase the incidence of hip fractures. Patients may remain hospitalized for several weeks, leading to one and a half million hospital bed days used each year. The reported incidence of a concurrent upper limb and a lower limb fracture is between 3% and 5%. It has been shown in the literature that patients who sustain both a hip fracture and an upper limb fracture have difficulties with rehabilitation which causes prolonged stays. The available literature on concomitant hip fracture and upper extremity fracture is limited. This study aimed to review patients with concurrent upper limb injury and hip fractures and to analyse the pattern of associated upper limb fractures, management of these fractures, length of hospital stay, mortality rates, and complications. Methodology We performed a retrospective data collection of all patients with a concomitant upper limb fracture and hip fracture from January 2017 to December 2020 at the University Hospital of Wales, Cardiff, United Kingdom. Patients were identified from the registers maintained in the ward. All patients aged over 60 years with a fragility hip fracture (managed operatively) and a concurrent upper limb fracture were included in the study. Patients aged less than 60 years were excluded. The local research department registered and approved this study as a service evaluation and therefore did not need ethical committee approval. The anatomical location of the upper limb and hip fractures was confirmed using the imaging database (Synapse). Results Of the 760 patients admitted with neck of femur fractures during this period, 39 (5.1%) patients had concomitant upper limb fractures. Only one upper limb fracture was managed with fixation, and for this study, that patient was excluded. Our retrospective search identified 38 patients, of whom 11 were men and 27 were women. Distal radius fractures were the most commonly associated upper limb fractures (55%). There was a significant increase in length of stay (43.6 days vs. 16.6 days) and delay in mobilization (58.9% vs. 81%) compared to an isolated hip fracture. There was no difference in the 30-day mortality rates. We were unable to collect the data for the Key Performance Indicator (KPI) of the National Institute for Health and Care Excellence compliant surgery, and this KPI was excluded from our study. Of the remaining five KPIs, our group of patients displayed better averages in three of the five categories, including prompt orthogeriatric review (92%), not delirious postoperatively (87%), and return to original residence (79%). Conclusions Due to the ageing population, hip fractures are increasing, and within one year of operation, have shown higher mortality rates. Annually, reports show that the worldwide incidence of fractures in the adult population ranges between 9.0 and 22.8 per 1,000. These fractures are more frequent in osteoporotic patients with weak bone quality. Following hip fractures, upper extremity fractures are the second most common among the osteoporotic, elderly population, with distal radius fractures being the most common. With the length of stay almost tripled (from 16.6 to 44.4 days), one can see this has a very big effect on costs in the National Health Service system.
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Affiliation(s)
| | - Abdul Badurudeen
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
| | - Tim Matthews
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
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Rocha P, Baixinho CL, Marques A, Henriques MA. Safety-promoting interventions for the older person with hip fracture on returning home: A systematic review. Int J Orthop Trauma Nurs 2024; 52:101063. [PMID: 37956633 DOI: 10.1016/j.ijotn.2023.101063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older adults with a prior history of falls that results in hip fractures have difficulties in regaining pre-fracture functional capacity. Scientific evidence has shown benefits of the implementation of multidimensional rehabilitation programs, but this evidence is not systematized with regard to continuity of care after hospital discharge. OBJECTIVE To identify interventions that promote safety and functional recovery of older adults with hip fractures after hospital discharge. METHOD A systematic review was carried out according to Cochrane methodology. The research strategy was predefined for the MEDLINE and CINAHL databases. The identified articles were screened according to the eligibility criteria by two independent reviewers. The articles included in the bibliographic sample were evaluated for risk of bias. RESULTS Of the 10,036 articles found, 10 were included in this systematic review. The safety-promoting interventions identified were: exercise training, occupational therapy/activities of daily living training, transfer and gait training, strengthening exercises, education on assistive device use, fall prevention education, nutritional assessment, environmental modifications/adjustments at home, use of an app, medication, self-care education, and support and counseling. CONCLUSIONS In eight studies analyzed, exercise training emerged as the most effective intervention for promoting the safety of older adults after hip fractures on returning home. Three studies associated two or more interventions, which focused on exercise training, occupational therapy/training of activities of daily living, and conventional postoperative rehabilitation with transfer and gait training, strengthening exercises, education on assistive device use and discharge planning, aiming to achieve muscle strengthening and safe gait, associated with the performance of activities of daily living.
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Affiliation(s)
- Paula Rocha
- Higher School of Health of Viseu; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisboa, Portugal; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-190, Lisboa, Portugal.
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, 1900-160, Lisboa, Portugal; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-190, Lisboa, Portugal; Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901, Leiria, Portugal.
| | - Andrea Marques
- Nursing School of Coimbra, Health Sciences Research Unit: Nursing (UICISA:E), 3000-232, Coimbra, Portugal; Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, 3000-071, Coimbra, Portugal.
| | - Maria Adriana Henriques
- Nursing School of Lisbon, 1900-160, Lisboa, Portugal; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-190, Lisboa, Portugal.
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Appleton E, Maeir T, Kaufman Y, Karni S, Gilboa Y. Cognitive Orientation to daily Occupational Performance (CO-OP) for Older Adults After a Hip Fracture: A Pilot Study. Am J Occup Ther 2023; 77:24038. [PMID: 36779978 PMCID: PMC9969984 DOI: 10.5014/ajot.2023.050073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
IMPORTANCE In-home therapy provides the opportunity for rehabilitation intervention to be completed in the context of the patient's natural environment. However, most studies have focused on the effects of physical exercise, leaving a gap in understanding the effectiveness of a more task-oriented intervention that addresses individual preferences. OBJECTIVE To assess the feasibility and preliminary efficacy of the Cognitive Orientation to daily Occupational PerformanceTM (CO-OP) approach, delivered at home with older adults after a hip fracture to improve functional outcomes. DESIGN Single-arm quasi-experimental design. SETTING Patients' home. PARTICIPANTS Nine participants (age ≥60 yr) being discharged home from an inpatient rehabilitation ward in a geriatric hospital in a central city in Israel. INTERVENTION Up to 10 1-hr weekly face-to-face sessions in using the CO-OP approach. OUTCOMES AND MEASURES The Canadian Occupational Performance Measure was used to measure performance and satisfaction with the patients' level of participation in daily functioning. RESULTS A 30% recruitment rate, an 81% retention rate, were observed, with 88% of the participants expressing high to very high overall satisfaction with the intervention. Friedman test results indicated statistically significant improvements in occupational performance and satisfaction on trained and untrained goals (p < .01). CONCLUSIONS AND RELEVANCE The findings suggest that a home-based CO-OP intervention is feasible and potentially beneficial for older adults who are returning home after a hip fracture. What This Article Adds: This study shows that a task-oriented intervention can be effective in helping older adults return home successfully after a hip fracture.
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Affiliation(s)
- Esther Appleton
- Esther Appleton, OT, MSc, is Occupational Therapist, Palace Medical, Tel Aviv, Israel
| | - Talia Maeir
- Talia Maeir, OT, MSC, is PhD Candidate, School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yakir Kaufman
- Yakir Kaufman, MD, MP, is Behavioral Neurologist and Head, Professional Standards Department, Division of General Medicine, Medical Directorate, Jerusalem, Israel Health Ministry, Israel
| | - Sharon Karni
- Sharon Karni, OT, MSc, is Head of Occupational Therapy Services, Herzog Hospital, Jerusalem, Israel
| | - Yafit Gilboa
- Yafit Gilboa, OT, PhD, is Senior Lecturer, School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel;
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Vestøl I, Debesay J, Bergland A. The journey of recovery after hip-facture surgery: older people's experiences of recovery through rehabilitation services involving physical activity. Disabil Rehabil 2021; 44:5468-5478. [PMID: 34121569 DOI: 10.1080/09638288.2021.1936659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: This study sought to explore and describe the experiences of recovery among community-living older people undergoing rehabilitation involving physical activity following hip-fracture surgery. Methods: We conducted in-depth interviews with 5 men and 16 women (age range: 67 - 84 years). The data were analysed by means of systematic text condensation.Results: The analysis revealed the following four interrelated themes: (1) what participants bring to the recovery situation matters; (2) support through individually tailored rehabilitation services, involving physical activity, - is key to recovery following hip fracture surgery; (3) needing professional help on the journey from helplessness and vulnerability to being more confident and active; and (4) making progress and regaining function represent the essence of recovery.Conclusions: All four identified themes relate to how physical activity, as an aspect of rehabilitation services, contributes to the recovery process for patients who have experienced a hip fracture. Differences were reported with regard to the services used, and all the participants were at the mercy of what their municipalities chose to offer in terms of rehabilitation services.IMPLICATIONS FOR REHABILITATIONMunicipal healthcare services should address patients' individual needs when planning, organising and implementing rehabilitation programmes involving physical activity.Healthcare professionals need to recognise older patients' experiences of reduced physical, psychological and social functioning following hip-fracture surgery and then take those experiences into account when tailoring rehabilitation programmes.Healthcare professionals providing physical rehabilitation programmes to people who have undergone hip-fracture surgery should take into account their patients' situation and lifestyle prior to experiencing a hip fracture.Municipal healthcare services should consider using recovery as a conceptual framework in relation to rehabilitation services involving physical activity.
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Affiliation(s)
- Irene Vestøl
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Choi JH, Kim BR, Nam KW, Lee SY, Beom J, Lee SY, Suh MJ, Lim JY. Effectiveness of a Home-Based Fragility Fracture Integrated Rehabilitation Management (FIRM) Program in Patients Surgically Treated for Hip Fractures. J Clin Med 2020; 10:jcm10010018. [PMID: 33374755 PMCID: PMC7794998 DOI: 10.3390/jcm10010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to investigate the effectiveness of a home-based fragility fracture integrated rehabilitation management (H-FIRM) program following an inpatient FIRM (I-FIRM) program in patients surgically treated for hip fracture. Methods: This nonrandomized controlled trial included 32 patients who underwent hip surgery for a fragility hip fracture. The patients were divided into two groups: a prospective intervention group (n = 16) and a historical control group (n = 16). The intervention group performed a nine-week H-FIRM program combined with the I-FIRM program. The historical control group performed the I-FIRM program only. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM) locomotion, Modified Rivermead Mobility Index (MRMI), 4 m walking speed test (4MWT), and the Korean version of Modified Barthel Index (K-MBI). All functional outcomes were assessed one week (before I-FIRM), three weeks (before I-FIRM), and three months (after H-FIRM) after surgery. Results: Both groups showed significant and clinically meaningful improvements in functional outcomes over time. Compared with the control group, the intervention group showed clinically meaningful improvements in Koval’s grade, FAC, FIM locomotion, MRMI, 4MWT, and K-MBI from baseline to three months. Conclusion: H-FIRM may be an effective intervention for improving functional outcomes in older people after fragility hip fractures.
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Affiliation(s)
- Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju 63241, Korea; (J.H.C.); (S.Y.L.)
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-02-920-6412; Fax: +82-02-929-9951
| | - Kwang Woo Nam
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju 63241, Korea;
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Korea;
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si 13620, Korea; (J.B.); (J.-Y.L.)
| | - So Young Lee
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju 63241, Korea; (J.H.C.); (S.Y.L.)
| | - Min Ji Suh
- Department of Rehabilitation Medicine, Seoqwipo Medical Center, Jeju 63585, Korea;
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si 13620, Korea; (J.B.); (J.-Y.L.)
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Gimigliano F, Liguori S, Moretti A, Toro G, Rauch A, Negrini S, Curci C, Patrini M, Peschi L, Pournajaf S, Sgarbanti M, Iolascon G. Systematic review of clinical practice guidelines for adults with fractures: identification of best evidence for rehabilitation to develop the WHO's Package of Interventions for Rehabilitation. J Orthop Traumatol 2020; 21:20. [PMID: 33188610 PMCID: PMC7666651 DOI: 10.1186/s10195-020-00560-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO's Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs. METHODS This paper is part of the Best Evidence for Rehabilitation (be4rehab) series, developed according to the methodology presented in the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR) introductory paper. It is a systematic review of existing CPGs on fractures in adult population published from 2009 to 2019. RESULTS We identified 23 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria, we selected 13 CPGs. After checking for quality, publication time, multiprofessionality, and comprehensiveness, we finally included five CPGs dealing with rehabilitative management of fractures in adult population, two CPGs addressing treatment of distal radius fracture and three the treatment of femoral/hip fracture. CONCLUSION The selected CPGs on management of distal radius and femoral/hip fracture include few recommendations regarding rehabilitation, with overall low to very low quality of evidence and weak/conditional strength of recommendation. Moreover, several gaps in specific rehabilitative topics occur. Further high-quality trials are required to upgrade the quality of the available evidence. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n. 1, 80138, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio n.4, 80138, Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio n.4, 80138, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio n.4, 80138, Naples, Italy
| | - Alexandra Rauch
- Rehabilitation Programme World Health Organization, Avenue Appia 20,, 1211, Geneva 27, Switzerland
| | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University La Statale, Milan, Italy
| | | | | | | | | | | | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio n.4, 80138, Naples, Italy
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