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Mashhadi-Naser S, Sabet FP, Nasiri M, Vasli P. Benefits of a family-based care transition program for older adults after hip fracture surgery. Aging Clin Exp Res 2024; 36:142. [PMID: 39002096 PMCID: PMC11246294 DOI: 10.1007/s40520-024-02794-8] [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: 05/22/2024] [Accepted: 06/21/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Hip fracture (HF) in older adults is strongly associated with a greater decline in their activities of daily living (ADLs) and health-related (HRQoL). The present study aimed to evaluate the effects of a family-based care transition program (FBCTP) on ADLs, HRQoL and social support in this age group after HF surgery. METHODS A quasi-experimental design was conducted on 100 older adults who had undergone HFS and were selected by convenience sampling and allocated to the IG (n = 50) and the CG (n = 50). Data were collected utilizing the Barthel Index, the 12-item Short Form Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support. The FBCTP was delivered in-hospital education sessions, home visit, and a follow-up and telephone counselling session. The data were collected at three stages, including the baseline, four weeks after discharge, and eight weeks later. The level of statistical significance was set at 0.05. RESULTS The results of the study indicated that the effects of time and group on the increase in ADLs were 15.2 and 36.69 (p < 0.000), respectively, following the completion of the FBCTP. Furthermore, time and group were found to have a positive effect on HRQoL, with an increase of 2.82 and 5.60 units, respectively (p < 0.000). In this context, time and group also interacted in the IG compared to the CG, with scores increasing by 1.86 units over time (p < 0.000). Although the study results indicated that social support improved by 1.98 units over time (p < 0.000), the effects of group alone and the time × group interaction were not statistically significant. This indicates that the program was not effective in accelerating social support. CONCLUSION Consequently, nurses, policymakers, and planners engaged in geriatric healthcare may utilize these results to enhance the health status of this age group following HFS.
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Affiliation(s)
- Sahar Mashhadi-Naser
- Student Research Committee, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Pashaei Sabet
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Vasli
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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2
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Taraldsen K, Polhemus A, Engdal M, Jansen CP, Becker C, Brenner N, Blain H, Johnsen LG, Vereijken B. Evaluation of mobility recovery after hip fracture: a scoping review of randomized controlled studies. Osteoporos Int 2024; 35:203-215. [PMID: 37801082 PMCID: PMC10837269 DOI: 10.1007/s00198-023-06922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
Few older adults regain their pre-fracture mobility after a hip fracture. Intervention studies evaluating effects on gait typically use short clinical tests or in-lab parameters that are often limited to gait speed only. Measurements of mobility in daily life settings exist and should be considered to a greater extent than today. Less than half of hip fracture patients regain their pre-fracture mobility. Mobility recovery is closely linked to health status and quality of life, but there is no comprehensive overview of how gait has been evaluated in intervention studies on hip fracture patients. The purpose was to identify what gait parameters have been used in randomized controlled trials to assess intervention effects on older people's mobility recovery after hip fracture. This scoping review is a secondary paper that identified relevant peer-reviewed and grey literature from 11 databases. After abstract and full-text screening, 24 papers from the original review and 8 from an updated search and manual screening were included. Records were eligible if they included gait parameters in RCTs on hip fracture patients. We included 32 papers from 29 trials (2754 unique participants). Gait parameters were primary endpoint in six studies only. Gait was predominantly evaluated as short walking, with gait speed being most frequently studied. Only five studies reported gait parameters from wearable sensors. Evidence on mobility improvement after interventions in hip fracture patients is largely limited to gait speed as assessed in a controlled setting. The transition from traditional clinical and in-lab to out-of-lab gait assessment is needed to assess effects of interventions on mobility recovery after hip fracture at higher granularity in all aspects of patients' lives, so that optimal care pathways can be defined.
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Affiliation(s)
- K Taraldsen
- Department of Rehabilitation Science and Health Technology, OsloMet, Oslo, Norway.
| | - A Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Engdal
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - C-P Jansen
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - N Brenner
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital and Montpellier University MUSE, Montpellier, France
| | - L G Johnsen
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
- Department of Orthopaedic Surgery, St. Olav's Hospital HF, Trondheim, Norway
| | - B Vereijken
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
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3
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Tedeschi R. "Case report: Integrating aerobic activity in post-surgical management of plurifragmentary distal clavicle fractures - A holistic approach to pain modulation and recovery". Int J Surg Case Rep 2023; 113:109024. [PMID: 37956497 PMCID: PMC10681916 DOI: 10.1016/j.ijscr.2023.109024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Clavicle fractures, particularly at the distal end, are common orthopedic injuries. While surgical interventions are often prioritized, the role of aerobic activity in post-operative pain modulation remains underexplored. CASE PRESENTATION A 34-year-old male presented with a plurifragmentary distal clavicle fracture following a direct trauma during a soccer match. Initial pain was severe (NPRS 6/7), with restricted shoulder mobility. Radiographic examinations confirmed the fracture. Following orthopedic consultation, the patient underwent surgical fixation using plate and screws. Post-operatively, pain management was uniquely addressed using low-impact aerobic activities, progressing from walking to running. At the 7-year follow-up, the patient reported optimal functional outcomes with a Disabilities of the Arm, Shoulder, and Hand (DASH) score of 0, highlighting the success of the combined approach. CLINICAL DISCUSSION The surgical intervention ensured anatomical alignment and stability, crucial for the healing of plurifragmentary fractures. The innovative approach of using aerobic activity for pain modulation post-surgery showcased significant pain reduction without consistent reliance on medications. CONCLUSIONS This case emphasizes the potential benefits of a comprehensive approach to clavicle fracture management. By integrating surgical intervention with aerobic activity for pain modulation, patients can achieve optimal long-term recovery and improved quality of life.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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4
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Groen WG, Wattel EM, de Groot AJ, Meiland FJM, Hertogh CMPM, Gerrits KHL. Exercise testing and training in frail older adults with an orthopedic impairment participating in a geriatric rehabilitation program: an international Delphi study. Eur Geriatr Med 2023; 14:985-997. [PMID: 37400662 PMCID: PMC10587272 DOI: 10.1007/s41999-023-00819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Little is known about exercise testing and training in orthopedic geriatric rehabilitation. This study aims to obtain expert-consensus-based recommendations on this matter. METHODS Using an online Delphi study we aimed to reach international expert consensus on statements related to testing and training of endurance capacity and muscle strength. Participants needed to have relevant research or clinical expertise. Statements were evaluated and explanatory comments could be provided. After each round anonymous results were presented to participants. Statements could be adjusted or new ones could be formulated if necessary. Consensus was defined as > 75% of participants agreeing. RESULTS Thirty experts completed the first round. Twenty-eight (93%) the second and 25 (83%) completed the third round. The majority of experts were physical therapists. Consensus was reached on a total of 34 statements. The statements and comments reflected the need for a pragmatic and tailored approach in this population both for testing and training. For example, for testing endurance capacity, a 6 Minute walk test was promoted and for testing muscle strength, performance in a functional activity was suggested. Ratings of perceived exertion were promoted for monitoring intensity of endurance and muscle strength training in patients without cognitive impairment. CONCLUSION In orthopedic GR, endurance and muscle strength testing should be pragmatic and is preferably performed in functional activities. For endurance training existing guidelines of the American College of Sports Medicine can be strived for but adapted as needed and for muscle strength training only lower intensities are agreed upon.
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Affiliation(s)
- Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, The Netherlands.
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Aafke J de Groot
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Franka J M Meiland
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin H L Gerrits
- Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- Merem Medische Revalidatie, Hilversum, The Netherlands
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5
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Pan RJ, Gui SJ, He YL, Nian F, Ni XY, Zhou YH, Wang MY, Wu JJ, Zeng GQ, Liang JH, Peng D. The effectiveness of optimal exercise-based strategy for patients with hip fracture: a systematic review and Bayesian network meta-analysis. Sci Rep 2023; 13:10521. [PMID: 37386114 PMCID: PMC10310779 DOI: 10.1038/s41598-023-37509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
The implementation of exercise intervention (EI) presents a promising and economical way for patients with hip fracture. However, the optimal type of EI remains unclear. The objective of this study is to evaluate the efficacy of various EI approaches and identify the optimal intervention for improving the prognosis of patients with hip fracture. A comprehensive search of Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, CINAHL, CNKI, Wan Fang, VIP, and CBM was conducted from their earliest records to June 2022. The included randomized controlled trials (RCTs) included at least one type of exercise for patients with hip fracture. The methodological quality of these trials was assessed using the Cochrane Collaboration Risk of Bias Tool. All direct and indirect comparisons were analyzed by Stata 14.0 and OpenBUGS 3.2.3 software. The primary outcome was hip function, and the secondary outcomes were activity of daily living (ADL), walking capacity and balance ability of patients. Based on the ranking probabilities, resistance exercise (RE) was ranked as the most effective among all exercise interventions (surface under cumulative ranking curve values [SUCRA]: 94.8%, [MD]: - 11.07, [Crl]: - 15.07 to - 7.08) in improving the efficacy of patients' hip function, followed by balance exercise (BE) ([SUCRA]:81.1%, [MD]: - 8.79, [Crl]: - 13.41 to - 4.18) and muscle strength exercise ([SUCRA]:57.6%, [MD]: - 5.35, [Crl]: - 9.70 to - 0.95). For the improvement of ADL for patients with hip fracture, BE ([SUCRA]:98.4%, [MD]: - 17.38, [Crl]: - 23.77 to - 11.04) may be the best EI. The findings of this study indicate that RE and BE might be the best approach to improve prognosis for patients with hip fracture. However, further rigorous and meticulously planned RCTs are required to substantiate the conclusions drawn from this study.
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Affiliation(s)
- Rong-Jia Pan
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Si-Jie Gui
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yu-Lian He
- Department of Orthopedics and Trauma, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Fang Nian
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Xiao-Yan Ni
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yan-Hui Zhou
- Department of Orthopedics and Trauma, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Man-Yi Wang
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Jing-Jing Wu
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Gu-Qing Zeng
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China.
| | - Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Dan Peng
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China.
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6
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Hulsbæk S, Laursen LB, Kristensen MT, Midtgaard J. Older patients' perspectives on participating in multimodal rehabilitation including anabolic steroids following hip fracture: a qualitative study embedded within a pilot RCT. Disabil Rehabil 2023; 45:81-89. [PMID: 35048770 DOI: 10.1080/09638288.2022.2025929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To explore patient perspectives of participating in a pilot RCT evaluating feasibility and effect of anabolic steroid, physiotherapy and nutritional supplement following hip fracture. METHODS Semi-structured telephone-based interviews of 16 women and three men (average age 73 years) were conducted at baseline and after a 12-week intervention. Qualitative content analysis was performed. RESULTS Two main categories were identified: (1) Trust and hope for a positive change with three sub-categories; reflections on anabolic steroids, anticipation of extra attention, lack of energy. (2) Curiosity, care, and commitment with four sub-categories; a sense of anabolic steroids, feeling of exclusivity and privileges, challenges and sense of obligation, and perspectives on personal gain. CONCLUSIONS Findings suggest high acceptability of the intervention. Participants motivated their participation on a trust that the intervention would "do more good than harm". They found the randomization and possibility of receiving anabolic steroids intriguing, and especially valued trial participation because of their experience of getting extra care and "deluxe" rehabilitation including close contact and support by health professionals. Our findings may help inform future research recruiting older patients and generally considered relevant for health professionals in rehabilitation, emphasizing the impact of professional guidance and social support to encourage self-efficacy.Implications for rehabilitationWith muscle enhancing medicine being suggested as a supplement in rehabilitation following hip fracture, exploring patients' perspectives is warranted and may help inform future trials in this area.Factors reported as important by older adults for engaging in rehabilitation trials are: simple but thorough information, friendly and trustful relation with study staff and opportunities of extra care and attention.Older patients with hip fracture highly valued professional guidance and support by health professionals during the rehabilitation intervention. High acceptability was identified for the supervised outpatient rehabilitation, where especially the individually structured progressive strength training was highlighted as the "active ingredient" accelerating recovery and potentially promoted self-efficacy.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Louise Bolvig Laursen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark.,Department of Physical- and Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Mental Health Centre Glostrup, Denmark
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7
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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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8
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Alajlouni DA, Bliuc D, Tran TS, Blank RD, Cawthon PM, Ensrud KE, Lane NE, Orwoll ES, Cauley JA, Center JR. Muscle Strength and Physical Performance Are Associated With Risk of Postfracture Mortality But Not Subsequent Fracture in Men. J Bone Miner Res 2022; 37:1571-1579. [PMID: 35689796 PMCID: PMC9378706 DOI: 10.1002/jbmr.4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/03/2022] [Revised: 05/10/2022] [Accepted: 06/04/2022] [Indexed: 11/14/2022]
Abstract
Muscle strength and physical performance are associated with incident fractures and mortality. However, their role in the risk of subsequent fracture and postfracture mortality is not clear. We assessed the association between muscle strength (grip strength) and performance (gait speed and chair stands time) and the risk of subsequent fracture and mortality in 830 men with low-trauma index fracture, who participated in the Osteoporotic Fractures in Men (MrOS) USA Study and had their index measurements assessed within 5 years prior to the index fracture. The annual decline in muscle strength and performance following index fracture, estimated using linear mixed-effects regression, was also examined in relation to mortality. The associations were assessed using Cox proportional hazards models adjusted for age, femoral neck bone mineral density (FN BMD), prior fractures, falls, body mass index (BMI), index fracture site, lifestyle factors, and comorbidities. Over a median follow-up of 3.7 (interquartile range [IQR], 1.3-8.1) years from index fracture to subsequent fracture, 201 (24%) men had a subsequent fracture and over 5.1 (IQR, 1.8-9.6) years to death, and 536 (65%) men died. Index measurements were not associated with subsequent fracture (hazard ratios [HRs] ranging from 0.97 to 1.07). However, they were associated with postfracture mortality. HR (95% confidence interval [CI]) per 1 standard deviation (1-SD) decrement in grip strength: HR 1.12 (95% CI, 1.01-1.25) and gait speed: HR 1.14 (95% CI, 1.02-1.27), and 1-SD increment in chair stands time: HR 1.08 (95% CI, 0.97-1.21). Greater annual declines in these measurements were associated with higher mortality risk, independent of the index values and other covariates. HR (95% CI) per 1-SD annual decrement in change in grip strength: HR 1.15 (95% CI, 1.01-1.33) and in gait speed: HR 1.38 (95% CI, 1.13-1.68), and 1-SD annual increment in chair stands time: HR 1.28 (95% CI, 1.07-1.54). Men who were unable to complete one or multiple tests had greater risk of postfracture mortality (24%-109%) compared to those performed all tests. It remains to be seen whether improvement in these modifiable factors can reduce postfracture mortality. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Dima A. Alajlouni
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
| | - Dana Bliuc
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
| | - Thach S. Tran
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
| | - Robert D. Blank
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
| | - Peggy M. Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California, San Francisco Coordinating CenterSan FranciscoCAUSA
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes ResearchMinneapolis VA Healthcare SystemMinneapolisMNUSA
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Nancy E. Lane
- Department of MedicineUniversity of California at Davis, School of MedicineSacramentoCAUSA
| | - Eric S. Orwoll
- Department of MedicineOregon Health and Science UniversityPortlandORUSA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Jacqueline R. Center
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
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9
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Ramadi A, Ezeugwu VE, Weber S, Funabashi M, Lima CA, Perracini MR, Beaupre LA. Progressive Resistance Training Program Characteristics in Rehabilitation Programs Following Hip Fracture: A Meta-Analysis and Meta-Regression. Geriatr Orthop Surg Rehabil 2022; 13:21514593221090799. [PMID: 35514534 PMCID: PMC9067046 DOI: 10.1177/21514593221090799] [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: 01/19/2022] [Revised: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Older adults often experience incomplete recovery after a hip fracture. Rehabilitation programs with progressive resistance training are associated with improved functional recovery. This systematic review and meta-analysis with meta-regression a) evaluated resistance training characteristics reported in hip fracture rehabilitation programs, b) performed meta-analysis of resistance training impact on strength (primary outcome), gait and physical activity (secondary outcomes), and c) explored resistance training program characteristics associated with improved outcomes using meta-regression. Materials and Methods: Medline, EMBASE, CINAHLPLUS, and Web of Science Core Collection databases were searched (January2000–February2021). Randomized controlled trials including progressive resistance training rehabilitation programs after hip fracture surgery in adults ≥50 years old were included. Meta-analyses and exploratory meta-regression were performed. Results: Meta-analysis showed significant increases in strength (10 trials-728 participants; Standardized Mean Difference (SMD) [95%CI]; .40 [.02, .78]) immediately following program completion in intervention relative to control participants. Meta-analysis on 5 trials (n = 384) with extended follow up found no significant group differences (SMD = .47 [-.28, 1.23]) in strength. Center-based relative to home-based programs were associated with significantly greater improvements in strength (P < .05) as were programs where resistance training intensity was prescribed using one-repetition maximum relative to other exercise prescription methods (P < .05). In gait meta-analysis (n = 10 trials-704 participants), gait speed in intervention participants immediately after the program was significantly higher than control (SMD = .42 [.08, .76]) but this finding was not maintained in extended follow-up (n = 5 trials-240 participants; SMD = .6 [-.26, .38]). Higher resistance training intensity was associated with significant improvements in gait speed (P < .05). No meta-analysis was performed for the 3 heterogeneous studies reporting physical activity. Discussion: Progressive resistance training improved muscle strength and gait speed after hip fracture surgery in adults ≥50years old immediately after the program ended, but the longer-term impact may be more limited. Conclusions: Higher resistance training intensity and center-based programs may be associated with more improvement, but require further research.
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Affiliation(s)
- Ailar Ramadi
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Victor E Ezeugwu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sydnie Weber
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Liu H, Wang Y, Li M, Chen D, Tang Y. Compliance of functional exercises in school-age children with limb fractures: implication for nursing countermeasures. BMC Pediatr 2022; 22:133. [PMID: 35287621 PMCID: PMC8919524 DOI: 10.1186/s12887-022-03193-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Functional exercises is very essential to the recovery of patients with fracture. We aimed to evaluate the compliance of functional exercises in school-age children with limb fracture, to provide evidence to the clinical management and nursing care of children with limb fracture. Methods School-age children with limb fractures treated in our hospital from January 1, 2020 to June 30, 2021 were selected. The characteristics and postoperative functional exercise compliance of included children were analyzed. Pearson correlation and Logistic regression analysis were conducted to analyze the influencing factors of compliance to functional exercises. Results A total of 328 children with limb fracture were included, the incidence of compliance to functional exercise was only 35.98%. Pearson correlation analysis showed that age(r = 0.707), only child of family(r = 0.537), guardians(r = 0.642) and type of temperament(r = 0.635) were correlated with compliance to functional exercises in school-age children with limb fractures (all p < 0.05). Logistic regression analysis indicated that age ≤ 10y (OR2.913, 95%CI2.091 ~ 3.611), only child of family (OR2.006, 95%CI1.683 ~ 2.558), guarded by grandparents (OR1.512, 95%CI1.201 ~ 2.118), non-easy-going temperament (OR4.127, 95%CI3.811 ~ 4.902) were the influencing factors of non-compliance to functional exercises in children with limb fracture (all p < 0.05). Conclusions School-age children have poor compliance with functional exercises after limb fractures, and there are many influencing factors. For children with those risks, health care providers should actively intervene in nursing to improve children’s exercise compliance and the rehabilitation effect.
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Affiliation(s)
- Hui Liu
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Wang
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mengya Li
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Chen
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China. .,Gulou District, No. 72, Guangzhou Road, Hunan Road Street, Nanjing City, Jiangsu Province, China.
| | - Yuping Tang
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China. .,Gulou District, No. 72, Guangzhou Road, Hunan Road Street, Nanjing City, Jiangsu Province, China.
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