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Guerra S, Ellmers T, Turabi R, Law M, Chauhan A, Milton-Cole R, Godfrey E, Sheehan KJ. Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review. Eur Geriatr Med 2024; 15:305-332. [PMID: 38418713 PMCID: PMC10997732 DOI: 10.1007/s41999-024-00936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. METHODS A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. RESULTS We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. CONCLUSION These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.
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Affiliation(s)
- Stefanny Guerra
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK.
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
| | - Toby Ellmers
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Ruqayyah Turabi
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Magda Law
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Aishwarya Chauhan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Emma Godfrey
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
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Murao M, Nankaku M, Kawano T, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty. Physiother Theory Pract 2023; 39:2438-2445. [PMID: 35581533 DOI: 10.1080/09593985.2022.2078255] [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: 08/13/2021] [Revised: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). METHODS Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. RESULTS The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. CONCLUSION The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.
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Affiliation(s)
- Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ulusoy İ, Yılmaz M, Kıvrak A. Efficacy of autologous stem cell therapy in femoral head avascular necrosis: a comparative study. J Orthop Surg Res 2023; 18:799. [PMID: 37875891 PMCID: PMC10598958 DOI: 10.1186/s13018-023-04297-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE Avascular necrosis of the femoral head is a disease usually seen in middle-aged individuals. Although many aetiological factors have been blamed, there are still aetiological factors that have not been fully elucidated. Although treatment options show a wide range, early and appropriate treatment is of great importance to preserve the hip joint. In our study, we compared the results of core decompression and core decompression combined with bone marrow mesenchymal stem cell implantation in patients with avascular necrosis of the femoral head. MATERIAL METHOD In this retrospective study, Steinberg stage 1-2 patients operated on for avascular necrosis of the femoral head between 2018 and 2023 were analysed. Separate groups were formed from patients who underwent isolated core decompression and core decompression + bone marrow mesenchymal stem cell implantation. Age, gender, Steinberg staging, aetiology of the disease, follow-up period, progression to hip arthroplasty, Vas scores, Harris hip scores (HHS), and complications were evaluated. Harris hip scores at preoperative and 2-year follow-up periods; VAS scores at preoperative, 3-month, 6-month, 1-year, and 2-year follow-up periods were analysed. RESULTS In the study, 44 patients were analysed. While 25 patients underwent core decompression only (group 1), 19 patients underwent core decompression and bone marrow mesenchymal stem cell implantation (group 2). The mean age of the patients in group 1 was 39.3 ± 6.5 years, and the mean age of the patients in group 2 was 38.4 ± 6.7 years. The mean follow-up was 31.85 ± 4.4 months in group 1 and 32.2 ± 4.1 months in group 2. Total hip arthroplasty was performed in 2 of the patients in group 1 (one of the patients underwent total hip arthroplasty at month 28 and the other at month 33). CONCLUSION The treatment of avascular necrosis of the femoral head varies according to various staging methods. Early diagnosis of the disease and correct treatment are very important for the patient's quality of life in the future. In our research, we found that patients who received both core decompression and stem cell implantation for early-stage avascular necrosis of the femoral head exhibited decreased pain at the 6-month, 1-year, and 2-year follow-up examinations. Additionally, their hip function improved at the 24-month mark according to the HHS evaluation.
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Alshammari MO, De Petrillo G, Epure LM, Huk OL, Zukor DJ, Antoniou J. Reply to Letter to the Editor: Regarding "Outcomes of Ceramic-On-Ceramic Bearing Total Hip Arthroplasty: A Minimum 10-Year Follow-Up Study". J Arthroplasty 2023; 38:e40-e41. [PMID: 37734832 DOI: 10.1016/j.arth.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Malek O Alshammari
- Department of Orthopaedics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gianni De Petrillo
- Department of Orthopaedics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Laura M Epure
- Department of Orthopaedics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Olga L Huk
- Department of Orthopaedics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David J Zukor
- Department of Orthopaedics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopaedics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Kalem M, Kocaoğlu H, Duman B, Şahin E, Yoğun Y, Ovali SA. Prospective Associations Between Fear of Falling, Anxiety, Depression, and Pain and Functional Outcomes Following Surgery for Intertrochanteric Hip Fracture. Geriatr Orthop Surg Rehabil 2023; 14:21514593231193234. [PMID: 37545567 PMCID: PMC10403981 DOI: 10.1177/21514593231193234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/23/2022] [Indexed: 08/08/2023] Open
Abstract
Objective Fear of falling, anxiety, depression, and pain levels are important risk factors for poor functional outcomes that may potentially be modifiable. We aimed to examine prospective associations between those factors following surgery for intertrochanteric hip fracture. Methods This study is a prospective observational cohort study of patients aged over 65 diagnosed with isolated intertrochanteric hip fracture. Three hundred and seventy patients who underwent intramedullary fixation surgery were screened; 188 cases were included in our final evaluation. Patients with any concomitant fracture, major psychiatric/neurocognitive and neurological disorders and those with any other major disease were excluded from the study. Age, Charlson Comorbidity Index (CCI), Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), Falls Efficacy Scale International (FES-I), and Visual Analog Scale (VAS) scores on the day of surgery (baseline) were evaluated as predictors of poor/good outcome at 90 days after surgery, by Harris Hip Score (HHS) with a cut-off score of 70. Results HHS score was significantly predicted at baseline by the full model [χ2 (7) = 18.18, P = .01]. However, only STAI-state scores were significantly added to the model [Exp (B) 95% CI: .92 (.86-.99)]. Conclusions In this prospective cohort study, we found that higher levels of anxiety state on the day of surgery predicts a poor outcome at 90 days following surgery. We did not find significant associations between other variables, including age, GDS, STAI-trait, FES-I, VAS, and CCI. This potentially modifiable psychological factor may inform surgeons and could be a potential mediator. Future prospective studies are needed to replicate these findings. Level of evidence Prognostic level I.
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Affiliation(s)
- Mahmut Kalem
- Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hakan Kocaoğlu
- Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Berker Duman
- Department of Psychiatry, Consultation-Liason Psychiatry, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ercan Şahin
- Department of Orthopedics and Traumatology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Yener Yoğun
- Department of Orthopedics and Traumatology, Hand Surgery Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sancar A. Ovali
- Department of Orthopedics and Traumatology, Turkish Ministry of Health Of State Hospital, Trabzon, Turkey
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Adebero T, Bobos P, Somerville L, Howard J, Vasarhelyi EM, Lanting B, Hunter SW. Implementation of falls risk evaluation at one-year after total hip arthroplasty: a cross-sectional study. Arch Physiother 2022; 12:16. [PMID: 35836298 PMCID: PMC9284763 DOI: 10.1186/s40945-022-00141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research has demonstrated an increased risk of falls after total hip arthroplasty (THA). Yet, people’s knowledge on falls risk factors and how falls prevention strategies are being used after THA have not been examined. If a person’s knowledge of falls and self-efficacy about falls prevention strategies is low this would indicate a pressing need for interventions to lessen risk. The study objectives were: 1) to determine the falls knowledge and what fall prevention strategies people used after (THA) and 2) to determine the outcomes of a falls risk assessment at 12-months after unilateral THA. Methods Overall, 108 people completed the Falls Risk for Older People – Community Setting (FROP-Com) scale, a falls questionnaire (covered occurrence of falls, knowledge on falls risk factors, falls prevention strategies implemented after THA surgery), 6-m Walk Test (6mWT), 30-Second Chair Stand Test (30CST), Timed-up and Go (TUG) Test, and Activities-specific Balance Confidence Scale (ABC). Results Twenty-five (23.2%) people fell at least once in the 12 months after THA. Scores on the FROP-Com ranged from 2–20 with an average of 8.2 ± 3.6 indicating a mild falls risk. The importance of falling compared to other health concerns was rated as moderate to high (6.8 ± 2.9) and the majority of participants (n = 98, 90.7%) believed falls can be prevented after THA. Total scores on the ABC scale ranged from 30.6% to 100.0% with an average score of 84.4 ± 15.5%, indicating high function. Only 47 people (43.5%) reported receiving falls prevention education. A total of 101 falls prevention strategies were completed by 67 people (62%), the most common strategy was environmental modifications (e.g., installation of grab bars) at 37.4%, while exercise was mentioned by only 2%. The majority of people had functional deficits in 30CST (62%) and TUG (76.9%) at 12-months after unilateral THA. Conclusions Almost a quarter of the sample had experienced a fall in the 12-months after THA and functional deficits were common. The majority of the sample had proactively implemented falls prevention strategies after the surgery. Yet importantly, people after THA had limited exposure to falls prevention education and implemented a limited range of prevention strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-022-00141-6.
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Affiliation(s)
- Tony Adebero
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Pavlos Bobos
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Lyndsay Somerville
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - James Howard
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Edward M Vasarhelyi
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Brent Lanting
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada. .,School of Physical Therapy, University of Western Ontario, London, ON, Canada.
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Gay JL, Cherof SA, LaFlamme CC, O’Connor PJ. Psychological Aspects of Stair Use: A Systematic Review. Am J Lifestyle Med 2022; 16:109-121. [PMID: 35185433 PMCID: PMC8848121 DOI: 10.1177/1559827619870104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/19/2019] [Accepted: 07/26/2019] [Indexed: 08/10/2023] Open
Abstract
Stair use, a common lifestyle activity, is a moderate-to-vigorous physical activity that, despite often being brief in duration, may contribute to psychological health. A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to summarize psychological aspects related to stair use. Included studies examined at least 1 psychological outcome in relation to either objective measures of stair use, such as time or stair height, or subjective measures of, or measures related to, stair use such as perceived difficulty using stairs. A total of 22 studies met the inclusion criteria; 12 used subjective stair use measures and 10 used objective stair use measures. The limited evidence from studies using self-reports supported that (1) perceived difficulty using stairs was positively associated with increased symptoms of anxiety and depression and (2) stair use was not associated with a reduced incidence of mental illnesses such as depression, suicide, or dementia. Studies using objective measures of stair use supported that (3) elevated symptoms of anxiety and depression are negatively associated with stair use performance. Given the widespread use of stairs, there is surprisingly little data about the extent to which, and for whom, stair use influences psychological health.
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Affiliation(s)
- Jennifer L. Gay
- Jennifer L. Gay, PhD, Department of Health Promotion and Behavior, University of Georgia, Athens, GA 30602; e-mail:
| | - Sarah A. Cherof
- Department of Health Promotion and Behavior (JLG, CCL), University of Georgia, Athens, Georgia
- Department of Kinesiology (SAC, PJO), University of Georgia, Athens, Georgia
| | - Chantal C. LaFlamme
- Department of Health Promotion and Behavior (JLG, CCL), University of Georgia, Athens, Georgia
- Department of Kinesiology (SAC, PJO), University of Georgia, Athens, Georgia
| | - Patrick J. O’Connor
- Department of Health Promotion and Behavior (JLG, CCL), University of Georgia, Athens, Georgia
- Department of Kinesiology (SAC, PJO), University of Georgia, Athens, Georgia
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Zhang H, Si W, Pi H. Incidence and risk factors related to fear of falling during the first mobilisation after total knee arthroplasty among older patients with knee osteoarthritis: A cross-sectional study. J Clin Nurs 2021; 30:2665-2672. [PMID: 33655557 DOI: 10.1111/jocn.15731] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The factors that lead to the fear of falling among older people after total knee arthroplasty (TKA) are poorly understood. The present study aims to examine the fear of falling among such patients and to determine the factors that are associated with that fear. METHODS A total of 285 patients aged ≥65 with knee osteoarthritis who underwent TKA at an orthopaedic hospital between November 2019 and May 2020 completed surveys about their own first mobilisation after TKA. They were asked to indicate whether they were afraid of falling by asking a single question, and what their pain level was on a visual analogue scale. They also completed the General Anxiety Disorder scale, the Geriatric Depression Scale-Short Form and the Social Support Rating Scale. Multivariate logistic regression was used to identify risk factors for fear of falling during the first mobilisation after TKA. This study was reported in compliance with the STROBE checklist for cross-sectional studies (see Supplementary File S1). RESULTS Just over half (56.5%) of participants reported being afraid of falling. Multivariate logistic regression identified three independent risk factors that explained a total of 31% of the variance in the fear of falling: female sex (odds ratio (OR) = 4.21, 95% confidence interval (CI) = 2.35-7.55), higher body mass index (OR =3.93, 95% CI =1.53-10.10) and higher anxiety (OR = 1.56, 95% CI = 1.37-1.78). CONCLUSIONS Many older patients fear falling when they begin to move after TKA, particularly women and those with higher body mass index or anxiety. These subgroups may merit special attention from healthcare professionals to mitigate their fears and optimise recovery after TKA.
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Affiliation(s)
- Huaguo Zhang
- Department of Nursing, Chinese PLA General Hospital, Beijing, China
| | - Wenteng Si
- Zhengzhou Orthopaedics Hospital, Zhengzhou, China
| | - Hongying Pi
- Department of Nursing, Chinese PLA General Hospital, Beijing, China
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Total Joint Arthroplasty Is Associated With a Decreased Risk of Traumatic Falls: An Analysis of 499,094 Cases. J Am Acad Orthop Surg 2020; 28:838-846. [PMID: 31834037 DOI: 10.5435/jaaos-d-19-00541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The rate of traumatic falls in the aging cohort is estimated to increase across the United States. We sought to determine whether patients with lower extremity osteoarthritis (OA) who underwent total joint arthroplasty (TJA) had a reduced risk of falling compared with those with OA who did not undergo TJA. METHODS The New York Statewide Planning and Research Cooperative System database was queried from 2000 to 2015 to identify 499,094 cases with primary diagnosis of hip or knee OA. Patients were stratified into 4 cohorts: group 1 (hip OA with total hip arthroplasty [THA] [N = 168,234]), group 2 (hip OA without THA [N = 22,482]), group 3 (knee OA with total knee arthroplasty [TKA] [N = 275,651]), and group 4 (knee OA without TKA [N = 32,826]). Patients were followed up longitudinally to evaluate the long-term risks of subsequent traumatic falls. Cox proportional hazards models were conducted to examine the relationship between patients' demographics and clinical characteristics and the risk of subsequent traumatic falls and reported as hazard ratios (HRs) with 95% confidence intervals (95% CIs). RESULTS Nineteen thousand seven hundred seventeen patients with hip OA underwent 168,234 primary THAs (88.2%), and 308,477 patients with knee OA underwent 275,651 primary TKAs (89.4%) during the period 2000 to 2015. Compared with patients without TJA, those who underwent TJA were at a decreased risk of falls (THA HR 0.56 [95% CI, 0.48 to 0.66]) and TKA HR 0.66 [95% CI, 0.57 to 0.76]). Compared with age 40 to 49 years, risk increases for ages 70 to 79 years (HR = 4.3, 95% CI: 2.8 to 6.6) and 80 years or older (HR = 5.5, 95% CI: 3.8 to 8.1). CONCLUSION TJA is associated with a decreased risk of long-term traumatic falls in elderly patients with the primary diagnosis of hip or knee osteoarthritis. LEVEL OF EVIDENCE Level III Retrospective Case-control study.
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Ninomiya K, Takahira N, Ikeda T, Suzuki K, Sato R, Hirakawa K. Predictors of falls in patients during the first year after total hip arthroplasty: A prospective cohort study. Health Sci Rep 2020; 3:e184. [PMID: 32832704 PMCID: PMC7436168 DOI: 10.1002/hsr2.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Since falls after total hip arthroplasty (THA) cause severe complications such as dislocation and fractures around the femoral stem, it is important to investigate what factors predict of falls. Thus, investigating predictors of falls in patients waiting for THA would be valuable as it lead to more strategic interventions to prevent these problems. The purpose of this study was to evaluate the predictors of falls in patients during the first year after THA. METHODS This is a prospective cohort study. A total of 157 patients who underwent THA for unilateral hip osteoarthritis were analyzed. The incidence of falls during the first year after THA was monitored, and patients were classified into a "faller" and "non-faller" group. The following factors were compared between the two groups: demographic data (age, sex, body mass index, leg length discrepancy, length of hospital stay, and history of falling), preoperative hip abductor muscle strength, functional performance (single leg stance and maximum walking speed), pain during walking, and physical activity. RESULTS On multivariate logistic regression analysis, preoperative hip abductor muscle strength on the affected side and a history of falling were predictors of falls during the first year after THA. On subsequent receiver operating characteristic curve analysis, preoperative hip abductor muscle strength on the affected side was retained as a significant predictor, with a cut-off strength of 0.46 Nm/kg differentiating the faller and non-faller groups with a specificity of 73.6%, specificity of 50.0%, and area under the curve of 70.2%. CONCLUSIONS Finding from the present study suggested that clinicians should focus on low preoperative hip abductor muscle strength on the affected side and a history of falling to prevent falls during the first year after THA.
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Affiliation(s)
- Kazunari Ninomiya
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
- Sensory and Motor ControlKitasato University Graduate School of Medical SciensesSagamiharaKanagawaJapan
| | - Naonobu Takahira
- Sensory and Motor ControlKitasato University Graduate School of Medical SciensesSagamiharaKanagawaJapan
- Department of RehabilitationSchool of Allied Health Sciences, Kitasato UniversitySagamiharaKanagawaJapan
| | - Takashi Ikeda
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
- Department of Nursing and Rehabilitation SciencesShowa UniversityTokyoJapan
| | - Koji Suzuki
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
| | - Ryoji Sato
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
| | - Kazuo Hirakawa
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
- Department of Orthopaedic SurgeryShonan Kamakura Joint Reconstruction Center, KamakuraKanagawaJapan
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Barbosa LG, Frazão CDS. Impact of demonstration in a realistic simulation environment as a postoperative education in patients' experience. EINSTEIN-SAO PAULO 2020; 18:eAO4831. [PMID: 32215467 PMCID: PMC7069733 DOI: 10.31744/einstein_journal/2020ao4831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. METHODS Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. RESULTS Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). CONCLUSION There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.
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Affiliation(s)
- Luciana Gardin Barbosa
- Associação de Assistência à Criança DeficienteSão PauloSPBrazil Associação de Assistência à Criança Deficiente , São Paulo , SP , Brazil .
| | - Cinthya da Silva Frazão
- Associação de Assistência à Criança DeficienteSão PauloSPBrazil Associação de Assistência à Criança Deficiente , São Paulo , SP , Brazil .
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Buker N, Eraslan U, Kitis A, Kiter AE, Akkaya S, Sutcu G. Is quality of life related to risk of falling, fear of falling, and functional status in patients with hip arthroplasty? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1772. [PMID: 30892811 DOI: 10.1002/pri.1772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 02/01/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the relation between health-related quality of life and risk of falling, fear of falling, and functional status in patients with hip arthroplasty. METHODS In this cross-sectional study, 48 hips of 45 patients who aged between 33 and 79 (53.56 ± 12.50) years and had cementless total hip arthroplasty between 2010 and 2014 were evaluated. Twenty-seven of the patients participated in the study were female (60.0%) and 18 were male (40.0%). Health-related quality of life with Nottingham Health Profile, function of the hip joint with Harris Hip Score, risk of falling with Performance-Oriented Motion Assessment I, and fear of falling with Falls Efficacy Scale were assessed. In addition, chair stand test, 40-m walk test, stair-climb test, and single leg stance test were carried out. In analysing the relationships between these parameters, Pearson correlation analysis was employed. The level of significance was considered as p < 0.05. RESULTS Among the cases, who were evaluated 87.10 ± 45.22 (22.43-214.71) weeks after the operation, a significant correlation was found between health-related quality of life and risk of falling, function of hip joint, and functional tests (p < 0.05). CONCLUSION The evaluation of the factors related to health-related quality of life in hip arthroplasty patients may help identify patient needs and guide the rehabilitation process.
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Affiliation(s)
- Nihal Buker
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Umut Eraslan
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ali Kitis
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ahmet Esat Kiter
- Department of Orthopedics and Traumatology, Medical Faculty of Pamukkale University, Denizli, Turkey
| | - Semih Akkaya
- Department of Orthopedics and Traumatology, Denizli Cerrahi Hastanesi, Denizli, Turkey
| | - Gulsah Sutcu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Kang JS, Suh YJ, Moon KH, Park JS, Roh TH, Park MH, Ryu DJ. Clinical efficiency of bone marrow mesenchymal stem cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression. Stem Cell Res Ther 2018; 9:274. [PMID: 30359323 PMCID: PMC6202854 DOI: 10.1186/s13287-018-1030-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/31/2018] [Accepted: 09/30/2018] [Indexed: 02/03/2023] Open
Abstract
Background To date, several trials have reported the use of mesenchymal stem cell (MSC) implantation for osteonecrosis of the femoral head (ONFH). However, the clinical outcomes have not been conclusive. This study compared the clinical and radiological results of bone marrow mesenchymal stem cell (BMMSC) implantation with traditional simple core decompression (CD) using a matched pair case–control design. Methods We retrospectively reviewed 100 patients with ONFH (106 hips) who had been treated by CD alone (50 patients, 53 hips) and CD + BMMSC implantation (50 patients, 53 hips) between February 2004 and October 2014. We assessed the total hip replacement arthroplasty (THA) conversion rate and ARCO (Association Research Circulation Osseous) stage progression. Survivor rate analysis was performed using the Kaplan–Meier method, and an additional THA was defined as the primary endpoints. Results The mean follow-up period was 4.28 years. There was a difference in the THA conversion rate between the CD (49%) and CD + BMMSC groups (28.3%) (p = 0.028). ARCO stage progression was noted in 20 of 53 hips (37.7%) in the CD group and 19 of 53 hips (35.8%) in the CD + BMMSC group. Among collapsed cases (ARCO stages III and IV), there was no difference in clinical failure rate between the two groups. Conversely, in the pre-collapse cases (ARCO stages I and II), only 6 of 30 hips (20%) progressed to clinical failure in the CD + BMMSC group, whereas 15 of 30 hips (50%) progressed to clinical failure in the CD group (p = 0.014). Kaplan–Meier survival analysis showed a significant difference in the time to failure between the two groups up to 10-year follow-up (log-rank test p = 0.031). There was no significant difference in terms of age (p = 0.87) and gender (p = 0.51) when comparing THA conversion rates between groups. No complication was noted. Conclusions These results suggest that implantation of MSCs into the femoral head at an early stage of ONFH lowers the THA conversion rate. However, ARCO stage progression is not affected by this treatment. Trial registration Retrospectively registered
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, South Korea
| | - Kyoung Ho Moon
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Jun Sung Park
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Tae Hoon Roh
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Myung Hoon Park
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea.
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Turhan Damar H, Bilik O, Karayurt O, Ursavas FE. Factors related to older patients' fear of falling during the first mobilization after total knee replacement and total hip replacement. Geriatr Nurs 2018; 39:382-387. [DOI: 10.1016/j.gerinurse.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 12/31/2022]
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Nagai K, Ikutomo H, Tagomori K, Miura N, Tsuboyama T, Masuhara K. Fear of Falling Restricts Activities of Daily Living after Total Hip Arthroplasty: A One-Year Longitudinal Study. Clin Gerontol 2018; 41:308-314. [PMID: 28990881 DOI: 10.1080/07317115.2017.1364682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the prevalence and time course in changes regarding the fear of falling and whether there are consequent restrictions in activities of daily living (ADL) after total hip arthroplasty (THA). METHODS This is 1-year longitudinal observational study. We recruited ninety-eight patients before and after THA. Fear of falling was assessed for 12 ADLs preoperatively and postoperatively at 3, 6, and 12 months following THA. In addition, we asked patients to answer whether they had refrained from performing each ADL because of fear of falling. RESULTS Fifty-two patients were enrolled for the analysis. The total fear of falling score during ADLs decreased with time after THA. The ADLs in which many patients (over 20%) felt fear even at 12 months were using the stairs (25%), sitting and standing from the floor (23%), and walking around the neighborhood (21%). Approximately 10% of patients were restricted in performing ADLs, such as sitting and standing from the floor, because of fear. CONCLUSIONS Patients undergoing THA frequently experience fear of falling during some ADLs even at 1 year after the operation, which could cause ADL restrictions. CLINICAL IMPLICATIONS Clinicians should evaluate fear of falling and institute rehabilitation programs individually to decrease excessive fear that might lead to ADL restrictions.
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Affiliation(s)
- Koutatsu Nagai
- a Department of Physical Therapy , School of Rehabilitation, Hyogo University of Health Sciences , Kobe , Japan
| | | | | | | | - Tadao Tsuboyama
- c Human Health Sciences, Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Torres LM, Turrini RNT, Merighi MAB. Patient readmission for orthopaedic surgical site infection: an hermeneutic phenomenological approach. J Clin Nurs 2017; 26:1011-1020. [DOI: 10.1111/jocn.13719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 11/26/2022]
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